ALTERATIONS IN RESPIRATORY STATUS - EARLY SIGNS OF SEVERE NECROTIZINGENTEROCOLITIS

Background: Necrotizing enterocolitis (NEC) presents with well-recogni zed signs of intestinal inflammation such as bilious vomiting, bloody stool, abdominal distension, and tenderness. The authors observed othe rwise unexplained changes in the respiratory status requiring increase d respiratory support during the 24 hours before direct evidence of th e intestinal disorder in patients with severe NEC. Methods: To study t his observation the authors collected data on 10 consecutive patients in whom NEC required an operation. Results: Eight of these patients we re recovering from respiratory distress syndrome (RDS). During the 24 hours before any direct sign of intestinal dysfunction seven of these eight had a respiratory prodrome needing increased respiratory support . Two patients required intubation and mechanical ventilation. Five ne eded increased supplemental oxygen. This prodrome included decreased o xygenation in seven, increased respiratory rate in five, and increased P-CO2 in five, preceded by hypocarbia in three. Conclusions: These ch anges in the respiratory condition revisit the concept of high output respiratory failure. This term was introduced to describe the respirat ory failure in adult patients who suffer acute intestinal illness. Inc reased metabolic demand from the intestinal illness was thought to str ess the ability of the patient to delivery oxygen and remove carbon di oxide. The ability of the respiratory system to meet the increased dem ands is limited by the intestinal dysfunction itself (abdominal pain a nd distension). In our patients recovering from RDS the pulmonary rese rve is inherently limited. Because they are carefully monitored, it is easy to retrieve evidence of respiratory changes that precede the dir ect signs of intestinal disease. In the earliest stages of intestinal illness before the direct signs of intestinal dysfunction, these patie nts often manifest unexplained signs of respiratory compensation and d ecompensation and require increased respiratory support. Regardless of the pathophysiology, these alterations in respiratory status represen t an early warning sign of NEC. Copyright (C) 1998 by W.B. Saunders Co mpany.