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Zhang H, Keszler M. Mechanical ventilation in special populations. Semin Perinatol 2024; 48:151888. [PMID: 38555219 DOI: 10.1016/j.semperi.2024.151888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Abstract
Optimal respiratory support can only be achieved if the ventilator strategy utilized for each individual patient at any given point in the evolution of their disease process is tailored to the underlying pathophysiology. The critically ill newborn infant requires individualized patient care when it comes to mechanical ventilation. This can only occur if the clinician has a good understanding of the different pathophysiologies of a variety of conditions that can lead to respiratory failure. In this chapter we describe the key pathophysiological features of bronchopulmonary dysplasia, meconium aspiration syndrome and lung hypoplasia syndromes with emphasis on congenital diaphragmatic hernia. We review available evidence to guide management an provide specific recommendations for pathophysiologically-based mechanical ventilation support.
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Affiliation(s)
- Hyayan Zhang
- Department of Neonatology, Perelman School of Medicine at the University of Pennsylvania, Newborn and Infant Chronic Lung Disease Program, Children's Hospital of Philadelphia, Philadelphia, PA, USA; Department of Neonatology, Guangzhou Women and Children Medical Center, Guangzhou, China
| | - Martin Keszler
- Department of Pediatrics, The Warren Alpert Medical School of Brown University, Providence, RI, USA.
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Courtney SE, van Kaam AH, Pillow JJ. Neonatal high frequency ventilation: Current trends and future directions. Semin Perinatol 2024; 48:151887. [PMID: 38556386 DOI: 10.1016/j.semperi.2024.151887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Abstract
High frequency ventilation (HFV) in neonates has been in use for over forty years. Some early HFV ventilators are no longer available, but high frequency oscillatory ventilation (HFOV) and jet ventilators (HFJV) continue to be commonly employed. Advanced HFOV models available outside of the United States are much quieter and easier to use, and are available as options on many conventional ventilators, providing important improvements such as tidal volume measurement and targeting. HFJV excels in treating air leak and non-homogenous lung disease and is often used for other diseases as well. High frequency non-invasive ventilation (hfNIV) is a novel application of HFV that remains under investigation. Similar to bubble CPAP, hfNIV has been applied with a variety of high-frequency ventilators. Efficacy and safety of hfNIV with any device have not yet been established. This article describes the current approaches to these HFV therapies and stresses the importance of understanding how each device works and what disease processes may respond best to the technology employed.
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Affiliation(s)
- Sherry E Courtney
- Department of Pediatrics, Section of Neonatology, University of Arkansas for Medical Sciences, Arkansas Children's Hospital, One Children's Way, Little Rock, AR 72202 USA.
| | - Anton H van Kaam
- Department of Neonatology, Emma Children's Hospital, Amsterdam UMC, Amsterdam Reproduction and Development Research Institute, Amsterdam, the Netherlands
| | - J Jane Pillow
- School of Human Sciences, University of Western Australia, Telethon Kids Institute, Perth, Australia
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Kimura S, Toyoshima K, Shimokaze T, Katsumata K, Saito T, Hoshino R. Respiratory function testing for guiding ventilator mode conversion in congenital diaphragmatic hernia. Pediatr Pulmonol 2024; 59:609-616. [PMID: 38206041 DOI: 10.1002/ppul.26789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 11/01/2023] [Accepted: 11/21/2023] [Indexed: 01/12/2024]
Abstract
INTRODUCTION For patients with a congenital diaphragmatic hernia, conventional mechanical ventilation (CMV) and high-frequency oscillatory ventilation (HFOV) are used in initial ventilatory management. HFOV has recently been recommended as a rescue therapy; however, we use HFOV for initial ventilation management, with a preoperative challenge test for CMV conversion and respiratory function testing at the time of CMV conversion. We aimed to compare patient characteristics between CMV conversion- and HFOV-preferred treatment groups. METHODS Ventilator settings and blood gases were retrospectively evaluated pre- and post-CMV conversion, and respiratory function tests for compliance of the respiratory system (Crs) and for resistance of the respiratory system (Rrs) were performed during the trial to CMV conversion. RESULTS No differences were observed between the CMV conversion- and HFOV-preferred groups regarding gestational age, birth weight, and observed/expected lung area-to-head circumference ratios. The median Crs (ml/cmH2 O/kg) and Rrs (cmH2 O・kg/L/s) in the CMV conversion- and HFOV-preferred groups was 0.42 versus 0.53 (p = .44) and 467 versus 327 (p = .045), respectively. The pre and posttrial amount of change in blood gas levels and ventilator parameters in the CMV conversion- and HFOV-preferred groups were as follows: mean airway pressure, -2.0 versus 0 cmH2 O; partial pressure of carbon dioxide, 6.1 versus 2.9 Torr; alveolar-arterial oxygen difference, -39.5 versus -50 Torr; and oxygenation index, -1.0 versus -0.6; respectively. CONCLUSION Respiratory function tests were useful in tailoring ventilator settings. Patients with high Rrs values responded better to CMV conversion.
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Affiliation(s)
- Sasagu Kimura
- Department of Neonatology, Kanagawa Children's Medical Center, Yokohama, Japan
- Department of Neonatology, Yamaguchi Prefectural Grand Medical Center, Hofu, Japan
| | - Katsuaki Toyoshima
- Department of Neonatology, Kanagawa Children's Medical Center, Yokohama, Japan
| | - Tomoyuki Shimokaze
- Department of Neonatology, Kanagawa Children's Medical Center, Yokohama, Japan
| | - Kaoru Katsumata
- Department of Neonatology, Kanagawa Children's Medical Center, Yokohama, Japan
| | - Tomoko Saito
- Department of Neonatology, Kanagawa Children's Medical Center, Yokohama, Japan
| | - Rikuo Hoshino
- Department of Neonatology, Kanagawa Children's Medical Center, Yokohama, Japan
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Al Kharusi AA, Al Maawali A, Traynor M, Adreak N, Ting J, Skarsgard ED. High frequency jet ventilation for congenital diaphragmatic hernia. J Pediatr Surg 2023; 58:799-802. [PMID: 36788056 DOI: 10.1016/j.jpedsurg.2023.01.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 01/03/2023] [Indexed: 01/22/2023]
Abstract
BACKGROUND The optimal role of high frequency jet ventilation (HFJV) in lung protective stabilization of congenital diaphragmatic hernia (CDH) remains uncertain. We aimed to describe our center's experience with HFJV as both a rescue (following failed stabilization with CMV) and primary ventilation mode in the management of CDH. METHODS Liveborn CDH patients treated from 2013 to 2021 in a single institution were reviewed. We compared 3 groups based on their primary and last ventilation mode prior to surgery: CMV (Group 1); HFJV (Group 2); and CMV/HFJV (Group 3). Outcomes included a composite primary outcome (≥1 of mortality, need for ECMO or need for supplemental O2 at discharge), total invasive ventilation days and development of pneumothorax. A descriptive analysis including univariate group comparisons was performed. Multivariate logistic regression models investigating the relationship between mode of ventilation and the primary outcome adjusted by potentially confounding covariates were constructed. RESULTS 56 patients (32 Group 1, 18 Group 2, 6 Group 3) were analyzed. Group 2 and 3 patients had more severe disease based on liver position, SNAP-II score, pulmonary hypertension severity, need for inotropic support, CDHSG defect size and need for patch repair. There were no group differences in survival, need for ECMO, or pneumothorax occurrence, although infants receiving HFJV required longer invasive ventilation and had a greater need for O2 at discharge. Multivariate logistic regression revealed no associations between mode of ventilation and outcome. CONCLUSIONS HFJV appears effective, both for CMV rescue and as a primary ventilation strategy in high risk CDH. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Al Anoud Al Kharusi
- Departments of Surgery, British Columbia Children's Hospital and the University of British Columbia, Vancouver, British Columbia, Canada
| | - Alghalya Al Maawali
- Departments of Surgery, British Columbia Children's Hospital and the University of British Columbia, Vancouver, British Columbia, Canada
| | - Michael Traynor
- Departments of Anesthesiology, British Columbia Children's Hospital and the University of British Columbia, Vancouver, British Columbia, Canada
| | - Najah Adreak
- Departments of Surgery, British Columbia Children's Hospital and the University of British Columbia, Vancouver, British Columbia, Canada
| | - Joseph Ting
- Division of Neonatology, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Erik D Skarsgard
- Departments of Surgery, British Columbia Children's Hospital and the University of British Columbia, Vancouver, British Columbia, Canada.
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Pala C, Blake SM. One Size Does Not Fit All: Congenital Diaphragmatic Hernia Management in Neonates. Neonatal Netw 2023; 42:45-51. [PMID: 36631262 DOI: 10.1891/nn-2021-0039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/02/2022] [Indexed: 01/13/2023]
Abstract
Congenital diaphragmatic hernia (CDH) results from abnormal development of the diaphragm during fetal life, allowing abdominal organs to herniate through the defect into the thorax. Stunted lung growth is associated with pulmonary hypoplasia and pulmonary hypertension, which are the primary sources of morbidity and mortality for this population. Despite strides in neonatal and surgical care, the management of neonates with CDH remains challenging. Optimal treatment strategies are still largely unknown. Many centers utilize gentle ventilation, permissive hypercapnia, and pulmonary hypertension treatment inclusive of nitric oxide, sildenafil, or epoprostenol, delayed surgical repair, and extracorporeal membrane oxygenation (ECMO). Evidence-based guidelines are needed to enhance CDH care practices and better outcomes. The successful management of CDH is a collaborative team effort from the prenatal to the postnatal period and beyond.
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Belli G, Dovadola I, Berti E, Padrini L, Agostini E, Serafini L, Ingargiola A, Gabbrielli G, Sandini E, Azzarà A, Catarzi S, Cioni ML, Petrucci L, Paternoster F, Moroni M. Safety use of high frequency oscillatory ventilation in transport of newborn infants affected by severe respiratory failure: preliminary data in central Tuscany. BMC Pediatr 2022; 22:335. [PMID: 35689179 PMCID: PMC9185983 DOI: 10.1186/s12887-022-03393-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 05/18/2022] [Indexed: 11/18/2022] Open
Abstract
Background Neonatal Emergency Transport Services play a fundamental role in neonatal care. Stabilization before transport of newborns suffering from severe respiratory failure is often a challenging problem and some critically ill infants may benefit from High Frequency Oscillatory Ventilation (HFOV) as rescue treatment. In these cases, transition to conventional ventilation for transport may cause a deterioration in clinical conditions. HFOV during neonatal transport has been only exceptionally used, due to technical difficulties. Since May 2018, a new neonatal transport unit is available at the Neonatal Protected Transport Service of the Meyer University Hospital in Florence, equipped with a pulmonary ventilator capable of delivering HFOV. Therefore, we conducted an analysis on patients transferred in HFOV to Neonatal Intensive Care Unit (NICU), in order to evaluate the safety and feasibility of its use during neonatal transport. Methods A retrospective analysis was performed reviewing medical records of the neonates transported by Meyer Children Hospital’s Neonatal Transport Service between May 2018 and December 2020, and newborns treated with HFOV during ground neonatal transport were identified. Safety was assessed by the comparison of vital signs, hemogas-analysis values and pulmonary ventilator parameters, at the time of departure and upon arrival in NICU. The dose of inotropes, the main respiratory complications (air leak, dislocation or obstruction of the endotracheal tube, loss of chest vibrations) and the number of deaths and transfer failures were recorded. Results Out of the approximate 400 newborns transported during the analysis period, 9 were transported in HFOV. We did not find any statistically significant difference in vital parameters, hemogas-analytical values and pulmonary ventilator settings recorded before and after neonatal transport of the nine patients’ parameters (p > 0,05). No patient required additional inotropes during transport. No transport-related deaths or significant complications occurred during transport. Conclusions The interest of our report is in the possibility of using HFOV during inter-hospital neonatal transfer. As far as our experience has shown, HFOV appears to be safe for the transportation of newborns with severe respiratory failure. Nevertheless, further larger, prospective and multicentre studies are needed to better evaluate the safety and efficacy of HFOV during neonatal transport.
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Affiliation(s)
- Gilda Belli
- Neonatal Intensive Care Unit, San Giovanni di Dio Hospital, Florence, Italy.
| | - Ilaria Dovadola
- Department of Women's and Children's Health, University of Padova, Padua, Italy
| | - Elettra Berti
- Neonatal Intensive Care Unit, Neonatal Emergency Transport Service, A. Meyer University Children's Hospital, Florence, Italy
| | - Letizia Padrini
- Neonatal Intensive Care Unit, Neonatal Emergency Transport Service, A. Meyer University Children's Hospital, Florence, Italy
| | - Elisabetta Agostini
- Neonatal Intensive Care Unit, Neonatal Emergency Transport Service, A. Meyer University Children's Hospital, Florence, Italy
| | - Lisa Serafini
- Neonatal Intensive Care Unit, Neonatal Emergency Transport Service, A. Meyer University Children's Hospital, Florence, Italy
| | - Anna Ingargiola
- Neonatal Intensive Care Unit, Neonatal Emergency Transport Service, A. Meyer University Children's Hospital, Florence, Italy
| | - Gabriella Gabbrielli
- Neonatal Intensive Care Unit, Neonatal Emergency Transport Service, A. Meyer University Children's Hospital, Florence, Italy
| | - Elena Sandini
- Neonatal Intensive Care Unit, Neonatal Emergency Transport Service, A. Meyer University Children's Hospital, Florence, Italy
| | - Angelo Azzarà
- Neonatal Intensive Care Unit, Neonatal Emergency Transport Service, A. Meyer University Children's Hospital, Florence, Italy
| | - Serena Catarzi
- Neonatal Intensive Care Unit, Neonatal Emergency Transport Service, A. Meyer University Children's Hospital, Florence, Italy
| | - Maria Luce Cioni
- Neonatal Intensive Care Unit, Neonatal Emergency Transport Service, A. Meyer University Children's Hospital, Florence, Italy
| | - Letizia Petrucci
- Neonatal Intensive Care Unit, Neonatal Emergency Transport Service, A. Meyer University Children's Hospital, Florence, Italy
| | - Filomena Paternoster
- Neonatal Intensive Care Unit, Neonatal Emergency Transport Service, A. Meyer University Children's Hospital, Florence, Italy
| | - Marco Moroni
- Neonatal Intensive Care Unit, Neonatal Emergency Transport Service, A. Meyer University Children's Hospital, Florence, Italy
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Rubalcava N, Norwitz GA, Kim AG, Weiner G, Matusko N, Arnold MA, Mychaliska GB, Perrone EE. Neonatal pneumothorax in congenital diaphragmatic hernia: Be wary of high ventilatory pressures. WORLD JOURNAL OF PEDIATRIC SURGERY 2022; 5:e000341. [DOI: 10.1136/wjps-2021-000341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 03/01/2022] [Indexed: 11/04/2022] Open
Abstract
BackgroundPatients with congenital diaphragmatic hernia (CDH) require invasive respiratory support and higher ventilator pressures may be associated with barotrauma. We sought to evaluate the risk factors associated with pneumothorax in CDH neonates prior to repair.MethodsWe retrospectively reviewed newborns born with CDH between 2014 and 2019 who developed a pneumothorax, and we matched these cases to patients with CDH without pneumothorax.ResultsTwenty-six patients were included (n=13 per group). The pneumothorax group required extracorporeal life support (ECLS) more frequently (85% vs 54%, p=0.04), particularly among type A/B defects (31% vs 7%, p=0.01). The pneumothorax group had higher positive end-expiratory pressure (PEEP) within 1 hour of birth (p=0.02), at pneumothorax diagnosis (p=0.003), and at ECLS (p=0.02). The pneumothorax group had a higher mean airway pressure (Paw) at birth (p=0.01), within 1 hour of birth (p=0.01), and at pneumothorax diagnosis (p=0.04). Using multiple logistic regression with cluster robust SEs, higher Paw (OR 2.2, 95% CI 1.08 to 3.72, p=0.03) and PEEP (OR 1.8, 95% CI 1.15 to 3.14, p=0.007) were associated with an increased risk of developing pneumothorax. There was no difference in survival (p=0.09).ConclusionsDevelopment of a pneumothorax in CDH neonates is independently associated with higher Paw and higher PEEP. A pneumothorax increases the likelihood of treated with ECLS, even with smaller defect.
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Yang MJ, Russell KW, Yoder BA, Fenton SJ. Congenital diaphragmatic hernia: a narrative review of controversies in neonatal management. Transl Pediatr 2021; 10:1432-1447. [PMID: 34189103 PMCID: PMC8192986 DOI: 10.21037/tp-20-142] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
The consequences of most hernias can be immediately corrected by surgical repair. However, this isn't always the case for children born with a congenital diaphragmatic hernia. The derangements in physiology encountered immediately after birth result from pulmonary hypoplasia and hypertension caused by herniation of abdominal contents into the chest early in lung development. This degree of physiologic compromise can vary from mild to severe. Postnatal management of these children remains controversial. Although heavily studied, multi-institutional randomized controlled trials are lacking to help determine what constitutes best practice. Additionally, the results of the many studies currently within the literature that have investigated differing aspect of care (i.e., inhaled nitric oxide, ventilator type, timing of repair, role of extracorporeal membrane oxygenation, etc.) are difficult to interpret due to the small numbers investigated, the varying degree of physiologic compromise, and the contrasting care that exists between institutions. The aim of this paper is to review areas of controversy in the care of these complex kids, mainly: the use of fraction of inspired oxygen, surfactant therapy, gentle ventilation, mode of ventilation, medical management of pulmonary hypertension (inhaled nitric oxide, sildenafil, milrinone, bosentan, prostaglandins), the utilization of extracorporeal membrane oxygenation, and the timing of surgical repair.
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Affiliation(s)
- Michelle J Yang
- Division of Neonatology, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Katie W Russell
- Division of Pediatric Surgery, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Bradley A Yoder
- Division of Neonatology, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Stephen J Fenton
- Division of Pediatric Surgery, University of Utah School of Medicine, Salt Lake City, UT, USA
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Williams E, Greenough A. Respiratory Support of Infants With Congenital Diaphragmatic Hernia. Front Pediatr 2021; 9:808317. [PMID: 35004552 PMCID: PMC8740288 DOI: 10.3389/fped.2021.808317] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 12/01/2021] [Indexed: 12/23/2022] Open
Abstract
Optimisation of respiratory support of infants with congenital diaphragmatic hernia (CDH) is critical. Infants with CDH often have severe lung hypoplasia and abnormal development of their pulmonary vasculature, leading to ventilation perfusion mismatch. It is vital that lung protective ventilation strategies are employed during both initial stabilisation and post-surgical repair to avoid ventilator induced lung damage and oxygen toxicity to prevent further impairment to an already diminished gas-exchanging environment. There is a lack of robust evidence for the routine use of surfactant therapy during initial resuscitation of infants with CDH and thus administration cannot be recommended outside clinical trials. Additionally, inhaled nitric oxide has been shown to have no benefit in reducing the mortality rates of infants with CDH. Other therapeutic agents which beneficially act on pulmonary hypertension are currently being assessed in infants with CDH in randomised multicentre trials. The role of novel ventilatory modalities such as closed loop automated oxygen control, liquid ventilation and heliox therapy may offer promise for infants with CDH, but the benefits need to be determined in appropriately designed clinical trials.
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Affiliation(s)
- Emma Williams
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom
| | - Anne Greenough
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom.,Asthma UK Centre for Allergic Mechanisms in Asthma, King's College London, London, United Kingdom.,National Institute for Health Research (NIHR) Biomedical Research Centre at Guy's and St Thomas' National Health Service (NHS) Foundation Trust and King's College London, London, United Kingdom
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Kimura S, Toyoshima K, Shimokaze T, Hoshino R. Using airway resistance measurement to determine when to switch ventilator modes in congenital diaphragmatic hernia: a case report. BMC Pediatr 2020; 20:365. [PMID: 32746793 PMCID: PMC7396326 DOI: 10.1186/s12887-020-02258-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 07/27/2020] [Indexed: 11/25/2022] Open
Abstract
Background Congenital diaphragmatic hernia is a deficiency of the fetal diaphragm resulting in herniation of the abdominal viscera into the thoracic cavity. The best method of respiratory management of congenital diaphragmatic hernia is unclear, but high frequency oscillatory ventilation is often used as the initial ventilator mode for severe congenital diaphragmatic hernia. When it becomes impossible to maintain the pre-ductal saturations, the timing of successful switching of the ventilation mode from high frequency oscillatory ventilation to conventional mechanical ventilation remains unclear. Herein, we reported two cases in which airway resistance measurements based on pulmonary function tests were used for making the decision to switch the ventilator mode from high frequency oscillatory ventilation to conventional mechanical ventilation in patients with left isolated congenital diaphragmatic hernia. Case presentation Two 0-day-old infants with congenital diaphragmatic hernia were admitted to our hospital. In both patients, high frequency oscillatory ventilation was started initially, and the levels of saturation gradually rose within a few hours after birth. After 24 h of high frequency oscillatory ventilation, the level of saturation decreased, and the dissociation of pre-ductal and post-ductal saturation re-occurred. The respiratory-system resistance was 515 and 403 cmH2O·kg/L/s, respectively. Because the respiratory-system resistance was elevated, we decided to change the ventilator mode from high frequency oscillatory ventilation to conventional mechanical ventilation. After switching to conventional mechanical ventilation, the patients’ heart rate and saturation increased immediately. Conclusions In patients with congenital diaphragmatic hernia, resistance levels of > 400 cmH2O·kg/L/s may indicate high airway resistance and suggest greater alveolar vibration attenuation. When respiratory-system resistance reaches over 400 cmH2O·kg/L/s, it may be an optimal time for switching from high frequency oscillatory ventilation to conventional mechanical ventilation.
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Affiliation(s)
- Sasagu Kimura
- Department of Neonatology, Kanagawa Children's Medical Center, 4-138-2 Mutsukawa Minamiku Yokohama, Yokohama, Kanagawa, 232-2351, Japan. .,Department of Pediatrics, Yamaguchi University Graduate School of Medicine, Ube, Japan.
| | - Katsuaki Toyoshima
- Department of Neonatology, Kanagawa Children's Medical Center, 4-138-2 Mutsukawa Minamiku Yokohama, Yokohama, Kanagawa, 232-2351, Japan
| | - Tomoaki Shimokaze
- Department of Neonatology, Kanagawa Children's Medical Center, 4-138-2 Mutsukawa Minamiku Yokohama, Yokohama, Kanagawa, 232-2351, Japan
| | - Rikuo Hoshino
- Department of Neonatology, Kanagawa Children's Medical Center, 4-138-2 Mutsukawa Minamiku Yokohama, Yokohama, Kanagawa, 232-2351, Japan
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