【体外膜肺ECMO精品课件】 High Frequency Ventilation in PPHN.pptVIP

HFV + Surfactant Survanta in term infants study group: Multicenter RCT on infants at risk for ECMO Surfactant use may reduce need for ECMO, especially when used early (OI 15-22) (Lotze et al. J Pediatr 132:40-7, 1998) Surfactant in MAS: 1/20 in surfactant gp vs. 6/20 controls needed ECMO 0/20 in surfactant gp vs. 5/20 controls had air leaks (Findlay et al. Pediatrics 97: 48-52, 1996) HFV + Surfactant No studies focusing on HFV + Surfactant in term neonates Studies in preterm neonates indicate that HFV: prolongs efficacy of surfactant reduces number of surfactant doses reduces pulmonary morbidity (Gerstmann et al. Pediatrics 98:1044, 1996; Clark and Gerstman. Clin Perinatol 25: 113-122, 1998) High Frequency Ventilation in PPHN Namasivayam Ambalavanan M.D. Division of Neonatology, Department of Pediatrics, University of Alabama at Birmingham Overview of presentation Introduction to PPHN Types of HFV Hyperventilation in PPHN HFOV, HFJV, and HFFI trials HFV techniques What is the problem? PPHN / PFC : persistence of the pattern of fetal circulation postnatally due to a sustained elevation of pulmonary vascular resistance, with right-to-left shunt at the ductus arteriosus or foramen ovale in the absence of structural heart disease Incidence:1: 522-1454. Exact incidence unknown in the absence of ICD coding or a “gold standard” for diagnosis Mortality and morbidity: mortality 50% in the absence of ECMO, and 10-20% with ECMO; 20% severe handicap/intracranial hemorrhage/deafness (Walsh-Sukys. Clin Perinatol 20: 127-143, 1993) Causes of PPHN (Geggel RL, Reid LM: Clin Perinatol 11:525, 1984) PPHN Normal Arterial Number Decreased Arteries e.g. CDH Normal muscularization Increased muscularization Developmental immaturity Maladaptation due to acute injury (commonest) e.g. Sepsis, MAS, asphyxia Chronic injury with vascular remodeling Malform- ation Current management Confirm diagnosis of PPHN Correct underlying abnormalities (hypothe