Sills J H, Cvetnic W G, Pietz J
Department of Pediatrics, University of California, Irvine Medical Center, Orange.
J Perinatol. 1989 Mar;9(1):43-8.
We report the successful use of continuous negative pressure (CNP) with standard intermittent mandatory ventilation (IMV) in five patients suffering from respiratory failure and persistent pulmonary hypertension of the newborn (PPHN). These infants all fulfilled criteria for use of extracorporeal membrane oxygenation (ECMO) with PaO2 less than 40 torr, alveolar-arterial oxygen difference (AaDO2) greater than 620 mm Hg, and oxygenation index (OI) greater than 50. Despite a considerable amount of conventional ventilation with mean airway pressures (PAW) between 14 and 26 cm water, none of these patients were able to improve oxygenation. All infants demonstrated significant improvement in ventilation requirements after initiation of CNP as reflected by a decrease in PAW, proximal inspiratory pressure (PIP), and IMV. Oxygenation dramatically improved in all infants. All five patients survived without any pulmonary or neurological complications at discharge. Availability of CNP may circumvent the need for ECMO in infants with severe lung disease and PPHN.
我们报告了在5例患有呼吸衰竭和新生儿持续性肺动脉高压（PPHN）的患者中，成功地将持续负压（CNP）与标准间歇指令通气（IMV）联合使用。这些婴儿均符合体外膜肺氧合（ECMO）的使用标准，即动脉血氧分压（PaO2）低于40托，肺泡-动脉血氧分压差（AaDO2）大于620毫米汞柱，以及氧合指数（OI）大于50。尽管使用了相当大量的传统通气，平均气道压（PAW）在14至26厘米水柱之间，但这些患者均未能改善氧合。开始使用CNP后，所有婴儿的通气需求均有显著改善，表现为PAW、近端吸气压力（PIP）和IMV降低。所有婴儿的氧合情况都得到了显著改善。所有5例患者出院时均存活，无任何肺部或神经并发症。对于患有严重肺部疾病和PPHN的婴儿，CNP的可用性可能避免了对ECMO的需求。
