HIGH-FREQUENCY OSCILLATORY VEBTILATION FOR NEONATAL MECONIUM ASPIRATION SYNDROME

Zeng JS, Li KH, Chui YT, Liu H, Chen XN, Fan XM

Beijing Children’s Hospital, Beijing, China

Objective: To evaluate the safety and effectiveness of high-frequency oscillatory ventilation (HFOV) using a protocal designed to recruit and maintain optimal lung volume in neonates with meconium aspiration syndrome (MAS).

Methods: 9 neonates with MAS were managed with HFOV using a lung volume recruitment strategy that consisted of incremental increases in mean airway pressure and lung volume to achieve an arterial oxygen saturation of ≥90% with FiO2 ≤0.4. Heart rate, arterial blood pressure, arterial blood gas analysis and the oxygenation index were monitored during the course of the high-frequency protocol.

Results: Eight neonates demonstrated that HFOV was effective for both improving oxygenation and maintaining gas exchange. The duration of HFOV varied from 2 to 8 (median 5) days. During the 48 hours after initiating HFOV, there were steady reductions in both mean airway pressure and FiO₂ .The mean airway pressure decreased from a mean of 22±3 to 15±4 (F=3.52,p<0.05) cmH₂O, and the FiO₂ decreased from a mean of 0.57±0.30 to 0.37±0.19 (F=2.72, p<0.05).After institution of HFOV, there was prompt improvement in oxygenation. The oxygenation index decreased from a mean of 13.7±3.1 to 6.1±2.2 ( F=3.58,p<0.05 ). No statistically significant changes was observed in amplitude pressure ,although the median decreased from a mean of 48±7 to 41±7 (F＝1.98，p>0.05) cmH₂O. No significant compromise in cardiac function was observed.

Conclusion: HFOV is both safe and effective in neonates with MAS. A lung volume recruitment strategy during HFOV produced improved gas exchange without significant compromise in cardiac function.

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