IDIOPATHIC PULMONARY HEMORRHAGE IN INFANCY - CLINICAL-FEATURES AND MANAGEMENT WITH HIGH-FREQUENCY VENTILATION

Study objectives: To describe the clinical characteristics of infants with severe acute pulmonary hemorrhage and the effects of mechanical v entilation on gas exchange. Setting: Tertiary care pediatric ICU in a university hospital. Patients and design: Case records of patients wit h severe acute pulmonary hemorrhage from January 1992 to July 1995 wer e reviewed, Acute pulmonary hemorrhage was defined as hemoptysis and/o r epistaxis or blood obtained from endotracheal tube which could not b e attributed to cardiac or vascular malformation, infectious process, or known trauma. Interventions: Patients were initially managed with c onventional ventilation. High frequency ventilation (HFV) was utilized when hypoxemia (PaO2/PAO(2)/O-2<0.2) and/or respiratory acidosis (PaC O2 greater than or equal to 60 mm Hg with pH<7.25) persisted. Measurem ents and results: Six African-American male infants from Detroit, with a median age 2.3 months, presented with severe acute pulmonary hemorr hage. Chest radiographs showed diffuse bilateral infiltrates or opacif ication with a normal sized heart. All infants were managed with HFV, four by oscillation and two by jet. The indications for HFV were persi stent hypoxemia (2), respiratory acidosis (1), and a combination of bo th (3). There was an improvement in pH and PaCO2, and a decreased need for oxygen 6 and 24 h after initiating HFV, PaO2/PAO(2) and oxygenati on index showed a tendency toward improvement. All infants survived, a nd there were no complications. No cause for pulmonary hemorrhage was found in any of the infants. Conclusions: Idiopathic acute pulmonary h emorrhage is a potentially life-threatening disorder encountered among inner-city infants, HFV is highly effective and safe in rapidly rever sing the severe oxygenation and ventilation deficits in this setting.