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LTC Thomas E. Wiswell, MC; MAJ Newton H. Foster, VC; LTC Michael V. Slayter, VC; CAPT Wayne E. Hachey, MC

Am J Dis Child. 1992;146(11):1287-1293.

Abstract
• Objective.
—To assess the usefulness of three methods of high-frequency ventilation in the early management of a piglet model of the meconium aspiration syndrome.

Design.
—Randomized, block design.

Setting.
—Animal research facility.

Subjects.
—Fifty-six mixed-breed newborn piglets aged 1 to 4 days and weighing 1.8 to 2.7 kg.

Interventions.
—After instillation of a 2.2-mL/kg solution of 25% meconium, 56 piglets were randomized to receive treatment with (1) a conventional positive-pressure infant ventilator, (2) the Bunnell Life Pulse high-frequency jet ventilator, (3) the Bird model VDR high-frequency flow interruptor, or (4) the Infant Star high-frequency flow interruptor. We adjusted ventilator settings to maintain partial pressures of arterial oxygen (Pao₂) of 80 to 120 cm H₂O and partial pressures of arterial carbon dioxide (Paco₂) of 30 to 50 cm H ₂O during the 6 hours of ventilation.

Measurements and Main Results.
—We compared pulmonary histologic alterations and four physiologic parameters: (1) mean airway pressure, (2) Paco₂, (3) ratio of Pao₂ to partial alveolar oxygen pressure (PAo₂), and (4) oxygenation index ([(fraction of inspired oxygen)(mean airway pressure)(100)]/Pao₂). The two measures of oxygenation were similar for all four devices except at 4 hours, when the Pao₂/PAo₂ ratio on positive-pressure ventilation was significantly higher than that on high-frequency jet ventilation (P=.008). The histologic changes on positive-pressure ventilation (atelectasis, inflammation, presence of meconium, and exudative debris) were significantly worse than those on high-frequency jet ventilation or flow interruption (P<.0001).

Conclusions.
—The finding of less severe pathologic alterations with various types of high-frequency ventilators justifies further investigations into the management of the meconium aspiration syndrome with these devices.

(AJDC. 1992;146:1287-1293)

Author Affiliations
USA; USA; USA; USA

From the Department of Pediatrics, Walter Reed Army Medical Center (Drs Wiswell and Hachey); the Walter Reed Army Institute of Research (Dr Foster); and the Armed Forces Institute of Pathology (Dr Slayter), Washington, DC.

Footnotes
Accepted for publication July 1, 1992.

Presented in part at the perinatology section of the annual meeting of the American Academy of Pediatrics, New Orleans, La, October 28, 1991.

The opinions or assertions contained herein are the private views of the authors and are not to be construed as official or as reflecting the views of the Department of the Army or the Department of Defense.

Reprint requests to Department of Pediatrics, Walter Reed Army Medical Center, 6825 16th St NW, Washington, DC 20307-5001 (Dr Wiswell).

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