CASE 1 (CIMS Neonatal & Paediatric Critical Care Services)

CIMS Neonatal & Paediatric Critical Care Services

We are sharing our use of SLE5000 (HFOV) with one of the most recommended technology which has unique feature of combining conventional mode with HFOV-providing ability to switch over to CMS to HFOV and vise versa.

Case 1 :

Diagnosis – Severe RDS (HMD) 26 weaker/900gms/male/aga with severe grunting presented at 32 hours of life with 60% Oxygen saturation and gasping respiration. Intubation was performed and ventilation was commenced (CMV).Child had extremely non compliant lungs with severe acidosis with Ph of 6.7 and Pco2 of 72 with Pao2 of 46.Rescue surfactant was given immediately but very transient response was achieved being late presentation. Commenced on HFOV with MAP of 18, Delta P of 40 and fio2 of 90 %. Gradually, child started improving lung recruitment was better on X-ray on day 3 of ventilation. Weaning was soon started with ABG analysis at 2,8,14 and 20 hours of starting HFOV and henceforth 8-12 hourly once ABG as per need clinically. On day (4) settings were minimal on HFOV with MAP of 10,Delta P of 25 and

Fi02 of 0.45.We switched over to CMV mode and continued weaning on traditional SIMV+PC mode for 3 days, sooner child was prepared for extubation which was successful.

Discussion –disease with Homogenous lung damage like HMD, ARDS can have best result with HFOV if used early in the setting how it was used in these patients. Newer Modalities and mode of HFOV like HFOV+CPAP is getting a wide acceptance during weaning of such patient and same was used in above patient for approximately 26 hours before extubation by Naso pharyngeal tube in situ. Recent data says that early and protocol based use of HFOV is not associated with any adverse outcome rather neurodevelopment is unaffected at all (1).

References:-

> Neuromotor outcome at 2 years of very preterm infants who were treated with high-frequency oscillatory ventilation or conventional ventilation for neonatal respiratory distress syndrome. Truffert P – Pediatrics – 01-APR-2007; 119(4): e860-5 (1)

> Soll R.F.: Prophylactic natural surfactant extract for preventing morbidity and mortality in preterm infants. Cochrane Database Syst Rev 2. 2000; CD000511 (4)