VENTILATOR MANAGEMENT OF INFANTS BEFORE EXTRACORPOREAL MEMBRANE-OXYGENATION

The aim of this project was to review the course of infants referred f or consideration of extracorporeal membrane oxygenation (ECMO) to iden tify maximal ventilator settings that, when exceeded, did not provide clinical benefit to the patient. These settings might then be used in defining failure of conventional mechanical ventilation. We reviewed r eferral records and hospital charts of all infants treated for severe respiratory failure due to meconium aspiration syndrome during the 52. 5 month period from March 15, 1985, to August 1, 1989. At an inspirato ry pressure >35 cm H2O, 75% (43/57) of patients eventually required EC MO, and 28% (4/14) of the infants who did not receive ECMO died. When the inspiratory pressure was greater than or equal to 40 cm H2O, 39/49 patients required ECMO, and 30% (3/10) of those not treated with ECMO died, Once the inspiratory pressure was >45 cm H2O, 91% (29/32) of pa tients required ECMO, and only one third of those not treated with ECM O survived. Although the limitations for conventional therapy suggeste d in this paper may be helpful to clinicians, each center needs to est ablish guidelines for maximal conventional ventilator support. If thes e guidelines are clearly defined, alternative methods of therapy can b e used once these criteria are achieved.