TRACHEAL SECRETION INPACTION DURING HYPERVENTILATION FOR PERSISTENT PULMONARY HYPERTENSION OF THE NEONATE

Abstract

We have recently observed at two institutions the occurrence of tracheal secretion casts or extensive mucous plugging in five neonates hyperventilated for Persistent Pulmonary Hypertension of the Neonate. This finding represents a significant clinical problem that can be recognized by pneumothoraces or CO₂ retention often in the face of adequate oxygenation. Tracheal suctioning or bronchoscopy may be necessary to remove the thick secretions. Five neonates were reviewed with mean BWt 3.51 kg, mean GA 39.6 wks. All infants were on the Bournes Bear Cub infant ventilator and all required max. insp. O₂ concentration of 100%. Ventilation was initiated at a mean of 11 hrs and these infants had been ventilated a mean of 191.4 hrs when the secretions were removed. At the time of recognition of tracheal plugs, mean ventilator settings were: inspired O₂ concentration 92%, rate 80 breaths/min, peak inspiratory pressure 55 cmH₂O, PEEP 4.4 cmH₂O, and mean arterial blood gas values were: PO₂ 68, PCO₂ 133, pH 7.25. All patients were on pancuronium and all had pneumothoraces associated with tracheal plugging. Large tracheal plugs were removed by suctioning in 2 infants, bronchoscopy in 2 infants and following jet ventilation in 1 infant. An increase in PCO₂ during hyperventilation with high rate and pressures and adequate PO₂ may signal tracheal plugs. Aggressive suctioning or bronchoscopy may be necessary to remove these plugs. Effective airway humidification systems are necessary for hyperventilation.

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