Original articlePreliminary observations of the use of high-frequency jet ventilation as rescue therapy in infants with congenital diaphragmatic hernia
Section snippets
Methods
We included all infants admitted to Duke University Medical Center Intensive Care Nursery with the diagnosis of CDH between January 2001 and August 2007. Patients were excluded from analysis if they had major congenital anomalies other than CDH or gestational age <37 weeks. Patients with CDH received HFJV when conventional mechanical ventilation (CMV) failed. Failure of CMV was defined as requiring a PIP greater than 26 cmH2O or MAP greater than 12 cmH2O to achieve a Paco2 less than 65 mm Hg.
Results
Thirty-one infants met inclusion criteria of gestational age 37 weeks or more and absence of other major congenital anomalies. Although the median birth weights of the HFJV and CMV groups were similar (Table 1), the patients that required HFJV during their care were initially more critically ill than the patients who only required CMV. Patients that required HFJV during their care had a lower median 5-minute Apgar score compared to the CMV group. The HFJV group received inhaled nitric oxide
Discussion
Congenital diaphragmatic hernia remains a complex and challenging disease, and clinicians caring for newborns with CDH are often faced with multiple pathophysiologic challenges including hypoplastic and dysmature lungs and maldeveloped pulmonary vasculature [13], [14]. Recent reports suggest improved survival from lung protective ventilation strategies, but there are no well-powered randomized clinical trials for testing any ventilatory strategies in these infants [9], high-frequency
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