TY - JOUR
T1 - Idiopathic pulmonary hemorrhage in infancy
T2 - Clinical features and management with high frequency ventilation
AU - Pappas, Michael D.
AU - Sarnaik, Ashok P.
AU - Meert, Kathleen L.
AU - Hasan, Rashed A.
AU - Lieh-Lai, Mary W.
PY - 1996
Y1 - 1996
N2 - Study objectives: To describe the clinical characteristics of infants with severe acute pulmonary hemorrhage and the effects of mechanical ventilation on gas exchange. Setting: Tertiary care pediatric ICU in a university hospital. Patients and design: Case records of patients with severe acute pulmonary hemorrhage from January 1992 to July 1995 were reviewed. Acute pulmonary hemorrhage was defined as hemoptysis and/or epistaxis or blood obtained from endotracheal tube which could not be attributed to cardiac or vascular malformation, infectious process, or known trauma. Interventions: Patients were initially managed with conventional ventilation. High frequency ventilation (HFV) was utilized when hypoxemia (PaO2/PAO2<0.2) and/or respiratory acidosis (PaCO2≤60 mm Hg with pH<7.25) persisted. Measurements and results: Six African-American male infants from Detroit, with a median age 2.3 months, presented with severe acute pulmonary hemorrhage. Chest radiographs showed diffuse bilateral infiltrates or opacification with a normal sized heart. All infants were managed with HFV, four by oscillation and two by jet. The indications for HFV were persistent hypoxemia (2), respiratory acidosis (1), and a combination of both (3). There was an improvement in pH and PaCO2, and a decreased need for oxygen 6 and 24 h after initiating HFV. PaO2/PaO2 and oxygenation index showed a tendency toward improvement. All infants survived, and there were no complications. No cause for pulmonary hemorrhage was found in any of the infants. Conclusions: Idiopathic acute pulmonary hemorrhage is a potentially life-threatening disorder encountered among inner-city infants. HFV is highly effective and safe in rapidly reversing the severe oxygenation and ventilation deficits in this setting.
AB - Study objectives: To describe the clinical characteristics of infants with severe acute pulmonary hemorrhage and the effects of mechanical ventilation on gas exchange. Setting: Tertiary care pediatric ICU in a university hospital. Patients and design: Case records of patients with severe acute pulmonary hemorrhage from January 1992 to July 1995 were reviewed. Acute pulmonary hemorrhage was defined as hemoptysis and/or epistaxis or blood obtained from endotracheal tube which could not be attributed to cardiac or vascular malformation, infectious process, or known trauma. Interventions: Patients were initially managed with conventional ventilation. High frequency ventilation (HFV) was utilized when hypoxemia (PaO2/PAO2<0.2) and/or respiratory acidosis (PaCO2≤60 mm Hg with pH<7.25) persisted. Measurements and results: Six African-American male infants from Detroit, with a median age 2.3 months, presented with severe acute pulmonary hemorrhage. Chest radiographs showed diffuse bilateral infiltrates or opacification with a normal sized heart. All infants were managed with HFV, four by oscillation and two by jet. The indications for HFV were persistent hypoxemia (2), respiratory acidosis (1), and a combination of both (3). There was an improvement in pH and PaCO2, and a decreased need for oxygen 6 and 24 h after initiating HFV. PaO2/PaO2 and oxygenation index showed a tendency toward improvement. All infants survived, and there were no complications. No cause for pulmonary hemorrhage was found in any of the infants. Conclusions: Idiopathic acute pulmonary hemorrhage is a potentially life-threatening disorder encountered among inner-city infants. HFV is highly effective and safe in rapidly reversing the severe oxygenation and ventilation deficits in this setting.
KW - high frequency ventilation
KW - mechanical ventilation
KW - pulmonary hemorrhage, infancy
UR - http://www.scopus.com/inward/record.url?scp=0029761757&partnerID=8YFLogxK
U2 - 10.1378/chest.110.2.553
DO - 10.1378/chest.110.2.553
M3 - Article
C2 - 8697865
AN - SCOPUS:0029761757
VL - 110
SP - 553
EP - 555
JO - Chest
JF - Chest
SN - 0012-3692
IS - 2
ER -