INTRATRACHEAL PULMONARY VENTILATION IN PREMATURE-INFANTS AND CHILDRENWITH INTRACTABLE HYPERCAPNIA

The feasibility of intratracheal pulmonary ventilation (ITPV) was test ed in five ventilated moribund neonatal and pediatric patients with un controllable hypercapnia: a 2-year-old child, a 52-day-old infant, and three premature infants (29, 29, and 26 weeks gestation; 1300 g, 1100 g and 890 g birth weight, respectively). ITPV was applied for 9.5, 8, 25, 58.5, and 47.5 hr, respectively. An intratracheal catheter (Cook Critical Care, Inc., Bloomington, IN) with a reversed continuous flow of gas at its tip (away from the lungs) allowed flushing of CO2 from t he proximal dead space. Marked reductions in Pa-CO2, ranging from 37% to 71% and improvement in pH were achieved within 4-6 hr of applying I TPV. During ITPV, the mean lowest Pa-CO2 was significantly less than t he pre-ITPV Pa-CO2 (P < 0.0017), and the mean best pH was significantl y higher than the pre-ITPV pH (p < 0.015). In four patients, despite s ignificant reductions in Pa-CO2, there was no substantial improvement in their baseline condition (shock and severe metabolic acidosis or co ma) and they were switched back to conventional ventilation. This led to worsening hypercapnia to pre-ITPV values. These four patients subse quently died. It is possible that these patients were already too ill to derive significant benefit from the technique. One premature infant survived, was successfully weaned to conventional ventilation and was eventually discharged home. ITPV can alleviate uncontrollable hyperca pnia in ventilated neonatal and pediatric patients.