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The incidence of congenital diaphragmatic hernia has been reported as 0.17–0.66 per 1,000 births. Despite advances in neonatal intensive care, congenital diaphragmatic hernia is associated with high mortality and morbidity. We report a neonate who was born with a left congenital diaphragmatic hernia and underwent surgical repair. The lack of ventilator flow response and flow cycling was identified via interpretation of the ventilator graphic and clinical assessment. Presumably, the ventilator failed to respond to the patient's peak inspiratory flow demand, despite the clinician's setting the highest peak flow available. A time-cycled pressure-limited mode with adjustable peak flow rate was the only option that met the infant's flow requirement, and alleviated the respiratory distress. This clinical finding follows bench research that raises the concern that so called “cradle-to-grave” ventilators may not optimally support all neonates.
- Correspondence: Brian K Walsh RRT-NPS RPFT FAARC, Respiratory Care Department, Children's Hospital Boston, 300 Longwood Avenue, MA-861, Boston MA 02115. E-mail: .
The authors have disclosed no conflicts of interest.
Nancy Craig RRT presented a version of this paper at the 54th International Respiratory Congress of the American Association for Respiratory Care, held December 13–16, 2008, in Anaheim, California.
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