TY - JOUR
T1 - Extracorporeal Membrane Oxygenation in the Treatment of Neonatal Respiratory Failure
AU - Foglia, R. P.
AU - Bjerke, H. S.
AU - Kelly, R. E.
AU - Phillips, J. D.
AU - Barcliff, L.
AU - Fonkalsrud, E. W.
PY - 1990/10
Y1 - 1990/10
N2 - • We report 18 consecutive neonates with severe respiratory failure due to pulmonary hypertension treated with extracorporeal membrane oxygenation. Extracorporeal membrane oxygenation was begun at 52 ± 36 hours of age with an arterial partial pressure of oxygen (Po2) of 36±14 mm Hg despite maximal pharmacologic and ventilator support (inspired fraction of oxygen [Fio2], 0.99±0.03; respiratory rate, 98±31/min; and positive inspiratory pressure, 54±11 cm of water). With initial flows of 130±17 mL/kg per minute, ventilator settings were reduced to the following: Fio2, 0.30; respiratory rates, 15/min; and positive inspiratory pressure, 24 cm of water. Support using extracorporeal membrane oxygenation was gradually reduced to 22% of initial flows and arterial blood samples showed pH 7.48 ±.05, Po2 of 106 ± 27 mm Hg, and Pco2 of 36 ± 5 mm Hg just prior to decannulation. After 107±45 hours, extracorporeal membrane oxygenation was stopped and infants were extubated 61 ±53 hours (median, 46 hours) afterward. There was one death (94.4% survival rate); all survivors were discharged and underwent a follow-up examination at 1 to 27 months of age. Complications included two intracranial hemorrhages (one death and one asymptomatic), one patent ductus arteriosis requiring ligation on extracorporeal membrane oxygenation, and chronic lung disease in one patient. In selected neonates, extracorporeal membrane oxygenation allows for resolution of pulmonary hypertension, results in improved survival, and is associated with a low incidence of chronic lung disease. Extracorporeal membrane oxygenation should be considered in the treatment of severe respiratory failure.
AB - • We report 18 consecutive neonates with severe respiratory failure due to pulmonary hypertension treated with extracorporeal membrane oxygenation. Extracorporeal membrane oxygenation was begun at 52 ± 36 hours of age with an arterial partial pressure of oxygen (Po2) of 36±14 mm Hg despite maximal pharmacologic and ventilator support (inspired fraction of oxygen [Fio2], 0.99±0.03; respiratory rate, 98±31/min; and positive inspiratory pressure, 54±11 cm of water). With initial flows of 130±17 mL/kg per minute, ventilator settings were reduced to the following: Fio2, 0.30; respiratory rates, 15/min; and positive inspiratory pressure, 24 cm of water. Support using extracorporeal membrane oxygenation was gradually reduced to 22% of initial flows and arterial blood samples showed pH 7.48 ±.05, Po2 of 106 ± 27 mm Hg, and Pco2 of 36 ± 5 mm Hg just prior to decannulation. After 107±45 hours, extracorporeal membrane oxygenation was stopped and infants were extubated 61 ±53 hours (median, 46 hours) afterward. There was one death (94.4% survival rate); all survivors were discharged and underwent a follow-up examination at 1 to 27 months of age. Complications included two intracranial hemorrhages (one death and one asymptomatic), one patent ductus arteriosis requiring ligation on extracorporeal membrane oxygenation, and chronic lung disease in one patient. In selected neonates, extracorporeal membrane oxygenation allows for resolution of pulmonary hypertension, results in improved survival, and is associated with a low incidence of chronic lung disease. Extracorporeal membrane oxygenation should be considered in the treatment of severe respiratory failure.
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U2 - 10.1001/archsurg.1990.01410220070010
DO - 10.1001/archsurg.1990.01410220070010
M3 - Article
C2 - 2121119
AN - SCOPUS:0025133051
SN - 0004-0010
VL - 125
SP - 1286
EP - 1292
JO - Archives of Surgery
JF - Archives of Surgery
IS - 10
ER -