RT Journal Article SR Electronic T1 Respiratory Distress Associated With Inadequate Mechanical Ventilator Flow Response in a Neonate With Congenital Diaphragmatic Hernia JF Respiratory Care FD American Association for Respiratory Care SP 342 OP 345 VO 55 IS 3 A1 Brian K Walsh A1 Nancy Craig A1 Peter Betit A1 John E Thompson A1 John H Arnold YR 2010 UL http://rc.rcjournal.com/content/55/3/342.abstract AB 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.