The Science Journal of the American Association for Respiratory Care

2000 OPEN FORUM Abstracts

SUCCESSFUL USE OF LOW LUNG INFLATION STRATEGY WITH HFOV IN A PREMATURE INFANT WITH AIR LEAK SYNDROME: A CASE REPORT

Stephen Dickson, MS,RRT, Gwinnett Medical Center, Ruben D. Restrepo, MD, RRT, Georgia State University, Atlanta, GA

BACKGROUND: Air Leak Syndrome (ALS) is a well-documented complication of conventional mechanical ventilation, occurring in 20-50% of all newborns. Several studies have reported that HFOV significantly reduces the development of air leak syndrome in infants with severe respiratory distress syndrome (RDS).(1)(2) We present the use of low mean airway pressure (Paw) with HFOV to resolve ALS in a premature patient with RDS. PATIENT: The patient was a 27-week gestation, 825 g female delivered by emergency C-section secondary to unstable pre-eclampsia. She was intubated, treated with surfactant replacement therapy and supported with conventional mechanical ventilation (CMV). At 22 hours of age, acute respiratory acidosis was noted, which was not corrected despite numerous changes on the ventilator. Ten hours later, severe ALS was confirmed by CXR revealing the presence of a left side pneumothorax, and pneumopericardium. The patient was then placed on HFOV using the SensorMedics 3100A. Initial settings were Paw=12, Delta P=20, Ti= 33%, FiO2= 0.68. During the next 8 hours, Paw was weaned to Paw=10. The patient was placed left side down. A CXR 44 hours after initiation of HFOV and dependent positioning revealed a dramatic resolution of air leak and significant atelectasis. After 9 days on HFOV, a CXR revealed normal lung inflation and a successful switchback to conventional ventilatory support (at FiO2 =.30 and Paw= 11 cm H2O) was possible. The infant was extubated and discharged home without evidence of IVH or significant BPD.
CONCLUSION: The use of a lower airway pressure (Paw) with HFOV provided significant advantages in this patient with a severe air leak syndrome. HFOV may be suggested not only to prevent but also to resolve the presence of air leak syndrome in neonatal patients with RDS. (1) Varnholt V, Lasch P, Kachel W, Diehm T, Koelfen W. [High frequency oscillatory ventilation of infants with severe respiratory disorders: possibilities, risks and limits]. Klin Padiatr 1994; 206(3):161-6. (2) Miyahara K, Ichihara T, Watanabe T. Successful use of HOFV for pneumomediastinum. Ann Thorac Cardiovasc Surg 1999; 5(1):49-51. (See Original for Figure)

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