Exchange transfusion using washed red blood cells reconstituted with fresh-frozen plasma for treatment of severe hyperkalemia in the neonate

Abstract

Typically, patients who showed no improvement with lateral decubitus positioning already had widespread bilateral pulmonary injury and were not good candidates for either selective bronchial obstruction or intubation. Whether Iobectomy or pleurotomy would have been beneficial is uncertain, but this would certainly have involved substantial risk in these critically ill neonates. Although lateral decubitus positioning frequently necessitated minor adjustments of ventilatory support, our patients tolerated it well and responded to this therapy. Our observations are in agreement with recent research 1~ that indicates that when infants are placed in the lateral decubitus position, the uppermost good lung receives a greater portion of ventilation. Thus, the lateral decubitus position appears to be a relatively benign, noninvasive therapeutic maneuver that should be attempted before more invasive methods are used to treat serious focal pulmonary interstitial emphysema. REFERENCES 1. Campbell RE: Intrapulmonary interstitial emphysema: A complication of hyaline membrane disease. Am J Roentgenol Rad Ther Nucl Med 110:449, 1970. 2. Leonidas JC, Hall RT, Rhodes PG: Conservative management of unilateral pulmonary interstitial emphysema under tension. J Pediatr 87:776, 1975. 3. Broo]~s JG, Bustamante SA, Koops BL: Selective bronchial intubation for the treatment of severe localized pulmonary interstitial emphysema in newborn infants. J Pediatr 91:648, 1977. 4. Dickman GL, Short BL, Krauss DR: Selective bronchial intubation in the management of unilateral pulmonary interstitial emphysema. Am J Dis Child 131:365, 1977. 5. Fletcher BD, Outerbridge EW, Youssef S, Bolande RP: Pulmonary interstitial emphysema in a newborn infant treated by lobectomy. Pediatrics 54:808, 1974. 6. Magilner AD, Capitanio MA, Wertheimer I, Burko H: Persistent localized intrapulmonary interstitial emphysema: An observation in three infants. Radiology 111:379, 1974. 7. Levine DH, Trump DS, Waterkotte G: Unilateral pulmonary interstitial emphysema: A surgical approach to treatment. Pediatrics 68:510, 1981. 8. Matthew OP, Thach BT: Selective bronchial obstruction for treatment of bullous interstitial emphysema. J Pediatr 96:475, 1980. 9. Swischuk LE: Bubbles in hyaline membrane disease. Radiology 122:417, 1977. 10. tteaf DP, Melms P, Gordon I, Turner HM: Postural effects on gas exchange in infants. N Engl J Med 308:i505, 1983.