Continuous positive airway pressure and conventional mechanical ventilation in the treatment of meconium aspiration syndrome

Abstract

Meconium aspiration syndrome (MAS) is a complex syndrome that ranges in severity from mild respiratory distress to severe respiratory failure, persistent pulmonary hypertension of the newborn and sometimes death. Understanding of the syndrome's complicated pathophysiology will help determine the appropriate treatment strategy, including the use of continuous positive airway pressure (CPAP), conventional mechanical ventilation (CMV) and other therapies. Approximately 30 to 50% of infants diagnosed with MAS will require CPAP or mechanical ventilation. The optimum modes of ventilation for MAS are not known. Very few studies have been conducted to determine 'best' ventilatory strategies. Despite the introduction, over the last two decades, of innovative ventilatory treatments for this disease (for example, surfactant, high-frequency ventilation, inhaled nitric oxide, extracorporeal membrane oxygenation), the majority of infants can be successfully managed with CPAP or mechanical ventilation alone.

Meconium aspiration syndrome: challenges and solutions

“…About 10% of those with severe MAS are treated by CPAP alone, delivered by binasal or single nasal prongs at a pressure of 5-8 cm H 2 O. 8 However, tolerance to CPAP device is often limited due to the relative maturity Research and 53 Despite more than four decades of ventilation of MAS infants, the optimal ventilatory management remains controversial with very few clinical trials upon which to base definite recommendations. This ensues because of complex pathophysiology involving areas of atelectasis coexisting with hyperinflation along with ventilation perfusion mismatch and airway compromise.…”

“…54 In infants with associated PPHN, higher rates (50-70) with higher FiO 2 (80%-100%) should be considered to maintain PaO 2 between 70 and 100 mm Hg and PaCO 2 between 35 and 45 mm Hg along with volume expansion, vasopressors, and other supportive measures. 53,54 Hyperventilation-induced alkalosis should be avoided due to risk of cerebral vasoconstriction-induced neurologic injury and sensorineural hearing loss. In such situations, other modalities like inhaled nitric oxide and high-frequency ventilation should be considered early.…”

Clinico-Aetiological Evaluation of Respiratory Distress in Newborn and Its Immediate Outcome Admitted in a Tertiary Care Teaching Hospital, South India

“…Ventilator management of the neonate with MAS is challenging because of the complicated pulmonary pathophysiology resulting from areas of both atelectasis and hyperinflation in association with ventilationperfusion mismatch and airway compromise. [31] Approximately, 40% of babies with MAS require mechanical ventilation and additional 10% require CPAP. Out of 54 cases of MAS in the present study 2 babies needed CPAP and 14 babies were ventilated, among which 4 babies expired.…”

A Prospective Study of Meconium Aspiration Syndrome in Newborns in a District Hospital in Southern India

“…MAS may be a severe condition as 30 to 50% of MAS required mechanical ventilation or continuous positive airway pressure (CPAP). (1,2) MAS is frequently associated with fetal hypoxia which promotes meconium discharge in amniotic fluid, gasping and aspiration of MSAF, and also changes in the vascular muscular media of pulmonary arteries of the fetus. (3,4) MSAF is found in 7 to 20% of pregnancies at the time of delivery.…”

“…(1) MAS is an infrequent but life-threatening respiratory disease affecting some of the infants born through meconium-stained amniotic fluid (MSAF). MAS may be a severe condition as 30 to 50% of MAS required mechanical ventilation or continuous positive airway pressure (CPAP).…”