MODERN TREATMENT MODALITIES FOR NEONATAL AND PEDIATRIC RESPIRATORY-FAILURE

BACKGROUND: Respiratory failure secondary to a variety of causes remai ns a significant cause of morbidity and mortality in the pediatric pop ulation. Newer therapies are appearing frequently in an attempt to dec rease the number of deaths from this disease state. We briefly review the current literature on some of the newer modalities including: high -frequency ventilation, surfactant, liquid ventilation, and nitric oxi de. We then present our experience from the past 11 years in the most invasive, yet successful, therapy for acute respiratory failure-- extr acorporeal membrane oxygenation (ECMO). METHODS: Retrospective review of all patients treated with ECMO from September 1983 to December 1994 was undertaken. Data were collected from bedside ECMO flow sheets and the standardized data entry forms submitted to the Extracorporeal Lif e Support Organization. All statistical analyses were performed using a standard statistical software program. RESULTS: During the study per iod, 194 neonates and 47 pediatric patients were treated with ECMO. Th e survival rate in the neonatal population is 82% and in the pediatric population it is 40%. The neonatal patients required an average of 15 3 hours of support while the pediatric patients required 220 hours (P= 0.008). CONCLUSIONS: While the newer treatment modalities discussed ma y have an important role in treating neonatal and pediatric respirator y failure in the near future, ECMO remains a cornerstone of the modern treatment modalities. Although somewhat invasive, ECMO is effective t herapy with increasing survival rates each year.