Bedside lung mechanics predict survival in hypoplastic lung disease

Newer bedside pulmonary mechanics using conventional ventilators allow for continuous serial determinations of tidal volume (V_T). We sought to determine whether the degree of pulmonary hypoplasia could be measured using bedside pulmonary graphics and whether survival could be predicted in potential extracorporeal membrane oxygenation (ECMO) candidates. Data on all neonates considered for or treated with ECMO at our center between April 2000 and March 2005 were collected. The maximal bedside V_T was measured daily at the peak pressure where beaking began with a peak end expiratory pressure of 4 cm H₂O. Twenty-two patients were reviewed: eight ECMO plus fourteen similar patients in whom the threshold for ECMO intervention was not achieved. Independent of need for ECMO, any patient with V_T of < 3 mL/kg or < 0.2 mL/cm length died (n = 4). All other measures of lung capacity or blood gas assessments were less valuable than V_T in predicting survival. We conclude that bedside V_T can be easily measured and that values < 3 mL/kg or < 0.2 mL/cm length demarcate severe lung hypoplasia, which in our patient population was incompatible with survival. We speculate that bedside V_T may assist in evaluating the utility of ECMO.