2011 OPEN FORUM Abstracts
NON-INVASIVELY MEASURED EXHALED BREATH CONDENSATE PH CAN DETECT PULMONARY DECOMPENSATION IN MECHANICALLY VENTILATED PRETERM NEONATES.
Alix Paget-Brown2, Scott T. Dwyer1, John F. Hunt1, Michael D. Davis1,2; 1Division of Pediatric Respiratory Medicine, University of Virginia, Charlottesville, VA; 2Division of Neonatology, University of Virginia, Charlottesville, VA
Introduction: Unless there is a witnessed event, with formula or blood suctioned from the endotracheal tube, determining airway health in mechanically ventilated preterm neonates is challenging. At best, infants with gestations < 27 weeks continue a pattern of shifting atelectasis which can be difficult to ascertain vs. VAP, hemorrhagic pulmonary edema, aspiration pneumonitis etc. The need for non-invasive monitoring of airway markers of inflammation is great. Case Summary: We connected an Airway Lining Fluid Analyzer (ALFA) (Respiratory Research, Inc., Austin TX) to the exhaust port of a Sensormedic high frequency oscillator (HFOV was the mode during the event for both infants). We have previously shown that continuous monitoring of EBC pH is possible in intubated preterm infants on both conventional and high frequency ventilation. Here we present two such infants: one of which had a witnessed formula-aspiration event with emesis and suctioning of formula from the endotracheal tube; the other infant presented with pulmonary hemorrhage. Both infants showed a previously steady baseline followed by rapid drop in EBC pH at the time of the event with slow recovery over 2 days to previous baseline. Discussion: We propose that continuous monitoring of EBC pH may be a useful tool in determining airway health in preterm mechanically ventilated neonates. VAP is incredibly difficult to diagnose in preterm infants, who can remain intubated for prolonged periods of time. Clinically silent aspiration events may also be occurring with only the need for increased ventilator settings as an outward sign. The ability to use a non-invasive tool in continuous fashion to monitor a marker of inflammation in this population may be able to direct further diagnostic workup and cultures, as opposed to continued shifting atelectasis which would contribute to an infant's otherwise stable baseline readings. Sponsored Research - This study was funded by a grant from the NIH.