HIGH-FREQUENCY MECHANICAL VENTILATION OF LOW-BIRTH-WEIGHT INFANTS WITH RESPIRATORY FAILURE FROM HYALINE MEMBRANE DISEASE: 92% SURVIVAL

Abstract

Infants with hyaline membrane disease (HMD) breathe rapidly with low tidal volumes. Mechanical ventilation of small preterm infants with HMD often induces crippling or lethal complications. In 3 months we treated 24 infants in respiratory failure -- birth weight 750-1750 g -- with a new method of ventilation intended to simulate the breathing pattern of infants with HMD. Our approach included (1) initial paralysis with pancuronium bromide, 0.04-0.08 mg/kg, (2) rapid respiratory frequencies (60-110/min, sometimes with brief hand-ventilation at rates up to 180/min), (3) peak-inflation pressures of less than 35 cmH2O, (4) end-expiratory pressures of 4-9 cmH2O, and (5) weaning from mechanical ventilation by reducing tidal volume until peak-inflation pressures reached 20-25 cmH2O, whereupon we decreased respiratory frequency. We kept PaCO2 at 30-40 torr, PaO2 at 60-80 torr. All babies were born at outside hospitals; their average weight was 1244 ± 301 g (7 < 1000 g) and their average gestation was 30 ± 2 weeks (6 < 28 weeks); 14/24 were male. 22/24 (92%) survived, and complications included: pneumothorax 2, intracranial hemorrhage 2, pulmonary hemorrhage 3, chronic lung disease 4, and patent ductus arteriosus 10, of which 3 required surgical ligation. We conclude that mechanical ventilation with rapid respiratory frequencies and low end-tidal pressures may be effective for treating small preterm infants with severe HMD and merits controlled evaluation.