PEDIATRICS Vol. 76 No. 4 October 1985, pp. 488-494
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Management of Infants With Severe Respiratory Failure and Persistence of the Fetal Circulation, Without Hyperventilation

Jen-Tien Wung MD1, L. Stanley James MD1, Eitan Kilchevsky MD1, and Edward James MD1

1 From the Division of Perinatal Medicine, Departments of Anesthesiology, Obstetrics, and Pediatrics, College of Physicians & Surgeons, Columbia University, New York

The successful management of 15 infants suffering from persistence of fetal pulmonary circulation and in severe respiratory failure is presented. The treatment regimen focused on minimizing barotrauma. Infants were intubated nasotracheally and ventilated with intermittent mandatory ventilation. Peak inspiratory pressures were determined by the clinical assessment of chest excursion. Ventilator settings and fractional inspiratory oxygen (FiO2) were selected to maintain a PaO2 between 50 and 70 mm Hg; PaCO2 was not a controlling parameter and was allowed to increase as high as 60 mm Hg. Hyperventilation and muscle relaxants were not used. High ventilator rate was used in ten infants who required high inspiratory pressure to maintain chest excursion, with a favorable response in five. Tolazoline was given to 14 infants of whom ten showed an improvement in oxygenation; dopamine was given to three infants who were oliguric. All infants survived, and only one infant developed chronic lung disease which was defined by the infant's need for supplemental oxygen beyond 30 days of life.

Key Words: respiratory failure • fetal circulation • hyperventilation

Submitted on June 27, 1985
Accepted on June 27, 1985




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