- OXYGEN INDEX: Important estimate of the severity of respiratory failure in
neonates- primarily based on oxygenation in relationship to level of ventilator support
and FiO2.
OI= (Mean Airway Pressure x FiO2%)
PaO2
OI<15, mild; OI 15-25 moderate and OI >25 severe respiratory failure.
New evidence suggests better outcomes if INO initiated at OI of 15-20. Traditionally INO
has been started at OI≥ 25
OI>30: Refer baby to ECMO Center and/or initiate pre-ECMO studies
OI>40 despite optimal therapy, including use of INO and other pulmonary vasodilators,
consideration of ECMO
TREATMENT:
Since PPHN is often a complication of underlying lung disease, treatment strategies
should also address associated lung disease. It is important to consider the lungs and
heart as one unit, connected by pulmonary circulation. Ideal management will involve
optimizing lung expansion and cardiac output while achieving pulmonary vasodilation
and maintaining systemic pressure. The target for PaO2 is 60-90 and should be
achieved while maintaining normal PaCO2. It is important to avoid excessive levels of