Application of respiratory support in perioperative period of congenital diaphragmatic hernia in neonates

Abstract

Objective To explore the ventilation strategies and treatment outcomes in the neonates with congenital diaphragmatic hernia(CDH) during perioperative period. Methods We conducted a retrospective study of 13 infants with CDH in our NICU.Infants with prenatal diagnosis of CDH should be intubated immediately after delivery, then they were transferred to NICU and gave ventilator support.During pre-operation period, high-frequency oscillatory ventilation(HFOV) mode was used as initial therapy.Neonates with CDH-associated pulmonary hypertension received inhaled nitric oxide(iNO) therapy.The surgical repair of CDH was usually delayed until physiologic stabilization and improvement of pulmonary hypertension.After surgical repair, we still used HFOV mode.According to the pre-operation parameter, the parameters of postoperative ventilation were regulated.The ventilator mode was changed to conventional ventilation(synchronized intermittent mandatory ventilation+ pressure support ventilation) when FiO2≤40%, mean airway pressure≤10 cmH2O(1 cmH2O=0.098 kPa), blood gas analysis resulted within normal range, the target preductal saturation range was 85% to 95%.When the babies' spontaneous respiration maintained stronger, FiO2≤30%, mean airway pressure≤8 cmH2O, SaO2, blood gas analysis resulted within normal range, thoracic X-ray showed the lung border on the contralateral side between the 8th and the 9th rib, then we weaned ventilator support. Results This gentle ventilation strategies were routinely used in our center, and made a good therapeutic effect in infants with CDH.Eleven of 13 CDH cases smoothly passed the ventilator support, no one developed into bronchopulmonary dysplasia. Conclusion Infants with CDH should be intubated immediately after birth and give ventilator support in perioperative period.This gentle ventilation strategy to avoid barotrauma until vital organs functions are stabilized.In order to improve the survival rate of infants with CDH, multidisciplinary collaboration become very important. Key words: Congenital diaphragmatic hernia; Perioperative period; Ventilation strategies; High-frequency oscillation ventilation