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Page 6/Case 03/01


Alkalinization is used to prevent pulmonary hypertension secondary to acidosis in patients with meconium aspiration syndrome. The use in CDH to prevent pulmonary hypertension is used based in the previous experience. However with permissive hypercapnia you may use HCO3-, to maintain pH close to 7.30.

By the time he was three days old he could be stabilised so as to undergo a surgical repair. A left postero-medial defect was repaired with a prosthetic patch.



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A chest tube was clamped on the third postoperative day and removed 24 hours later. He received total parenteral nutritional support.



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Here is his ventilatory history:
– HFOV x 7 days
– High frequency jet ventilation (HFJV) x 5days
– the switch was made due to CO2 retention and hypoxemia.
– PCV/VG x 6 days (pressure- controlled ventilation, volume guaranteed)
– PSV/VG x 4 days (Pressure support ventilation, volume guaranteed)
– Extubated and given supplemental O2 at a rate of 0.5 L/min via nasal prongs

The ventilatory management in this centre started with HFOV and then switched to conventional ventilation. ECMO is not available. The use of HFJT in this case was due to CO2 retention related to the accumulation of secretions.



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WHAT IS THE MANAGEMENT AT YOUR CENTRE?


As explained above, there are different ventilatory approaches, but most of the centres agreed with "gentle ventilation".


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