[Early high frequency oscillatory ventilation in infants with severe meconium aspiration syndrome]

ABSTRACT

Objective of the Study to evaluate the effectiveness of early high frequency oscillatory ventilation [HFO] in the management of infants with severe meconium aspiration syndrome [MAS]. Patients and methods 26 infants [gestational age 40 weeks +/- 2 days, birth weight 3460 g +/- 497] with MAS and acute hypoxemic respiratory failure requiring mechanical ventilation [oxygenation index [OI] 13, 5 +/- 8, alveolo-arterial difference of oxygen [D[A-a]O2] 455 +/- 159 mmHg] were included in the study. Fourteen [54 per cent] of them had a pulmonary air leak at admission. Seven infants [group 1], admitted before the year 2000, were managed with conventional mechanical ventilation [CMV] and were evaluated retrospectively. Nineteen patients [group 2], managed after the year 2000, were treated with HFO only, or with CMV relayed very early by HFO when CMV failed [FiO2>50 percent and/or peak inspiratory pressure >24 cmH2O].This group was evaluated prospectively. In the two groups, NOi was associated to the treatment when the FiO2 required remained superior to 60 per cent after 1 hour of mechanical ventilation. The two groups were comparable concerning their initial oxygenation parameters, and the percentage of patients with pulmonary air leak. The course of the oxygenation parameters, in the two groups, was studied using the test of Spearman