High-frequency vs. conventional ventilation at the time of CDH repair is not associated with higher mortality and oxygen dependency: a retrospective cohort study

Derraugh, Gabrielle; Levesque, Matthew; Schantz, Daryl; Sesha, Molly; Minski, John; Baier, John; Morris, Mélanie; Shawyer, Anna C.; Balshaw, Robert; Min, Suyin A. Lum; Keijzer, Richard

doi:10.1007/s00383-020-04740-x

Cited by 11 publications

(5 citation statements)

References 20 publications

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“…That study, however, is limited by its retrospective nature, although propensity score matching was performed to reduce potential confounding. Furthermore, no significant difference was reported between mode of respiratory support (HFOV or CMV) at the time of surgical repair when considering oxygen dependency or death at 28 days (16). Use of high positive end-expiratory pressure (PEEP) may cause lung injury by over-inflation of the ipsilateral lung during HFOV and the ensuing pulmonary inflammatory response (12,17).…”

Section: Initial Ventilatory Management Pre-surgerymentioning

confidence: 99%

Respiratory Support of Infants With Congenital Diaphragmatic Hernia

Williams

Greenough

2021

Front. Pediatr.

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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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Section: Initial Ventilatory Management Pre-surgerymentioning

confidence: 99%

Respiratory Support of Infants With Congenital Diaphragmatic Hernia

Williams

Greenough

2021

Front. Pediatr.

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“…The association between iNO, HFOV, Prostin, and death indicates that these therapies were applied to the sickest babies. We suggest the failure of others to demonstrate this indicates the therapies being applied to babies who could have survived without their use 30 31. Some reports use iNO in 70% of cases,32 which seems difficult to reconcile with our figure of 45% of cases requiring iNO.…”

Section: Discussionmentioning

confidence: 55%

Congenital diaphragmatic hernia survival in an English regional ECMO center

O’Connor

Tamura

Hannon

et al. 2023

World Jnl Ped Surgery

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IntroductionCongenital diaphragmatic hernia (CDH) remains a cause of neonatal death. Our aims are to describe contemporary rates of survival and the variables associated with this outcome, contrasting these with our study of two decades earlier and recent reports.Materials and methodsA retrospective review of all infants diagnosed in a regional center between January 2000 and December 2020 was performed. The outcome of interest was survival. Possible explanatory variables included side of defect, use of complex ventilatory or hemodynamic strategies (inhaled nitric oxide (iNO), high-frequency oscillatory ventilation (HFOV), extracorporeal membrane oxygenation (ECMO), and Prostin), presence of antenatal diagnosis, associated anomalies, birth weight, and gestation. Temporal changes were studied by measuring outcomes in each of four consecutive 63-month periods.ResultsA total of 225 cases were diagnosed. Survival was 60% (134 of 225). Postnatal survival was 68% (134 of 198 liveborn), and postrepair survival was 84% (134 of 159 who survived to repair). Diagnosis was made antenatally in 66% of cases. Variables associated with mortality were the need for complex ventilatory strategies (iNO, HFOV, Prostin, and ECMO), antenatal diagnosis, right-sided defects, use of patch repair, associated anomalies, birth weight, and gestation. Survival has improved from our report of a prior decade and did not vary during the study period. Postnatal survival has improved despite fewer terminations. On multivariate analysis, the need for complex ventilation was the strongest predictor of death (OR=50, 95% CI 13 to 224, p<0.0001), and associated anomalies ceased to be predictive.ConclusionsSurvival has improved from our earlier report, despite reduced numbers of terminations. This may be related to increased use of complex ventilatory strategies.

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“…Two retrospective studies comparing conventional ventilation with high-frequency ventilation (HFV) were unable to show any difference in survival, need for inhaled nitric oxide (iNO), duration of mechanical ventilation or oxygen requirement at discharge. The study by Derraugh et al 49 was based on experience at a single non-ECLS centre over a 25-year period. The HFV group included patients managed with both high-frequency jet ventilation and HFOV.…”

Section: Resultsmentioning

confidence: 99%

Diagnosis and management of congenital diaphragmatic hernia: a 2023 update from the Canadian Congenital Diaphragmatic Hernia Collaborative

Puligandla,

Skarsgard,

Baird

et al. 2023

Arch Dis Child Fetal Neonatal Ed

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ObjectiveThe Canadian Congenital Diaphragmatic Hernia (CDH) Collaborative sought to make its existing clinical practice guideline, published in 2018, into a ‘living document’.Design and main outcome measuresCritical appraisal of CDH literature adhering to Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology. Evidence accumulated between 1 January 2017 and 30 August 2022 was analysed to inform changes to existing or the development of new CDH care recommendations. Strength of consensus was also determined using a modified Delphi process among national experts in the field.ResultsOf the 3868 articles retrieved in our search that covered the 15 areas of CDH care, 459 underwent full-text review. Ultimately, 103 articles were used to inform 20 changes to existing recommendations, which included aspects related to prenatal diagnosis, echocardiographic evaluation, pulmonary hypertension management, surgical readiness criteria, the type of surgical repair and long-term health surveillance. Fifteen new CDH care recommendations were also created using this evidence, with most related to the management of pain and the provision of analgesia and neuromuscular blockade for patients with CDH.ConclusionsThe 2023 Canadian CDH Collaborative’s clinical practice guideline update provides a management framework for infants and children with CDH based on the best available evidence and expert consensus.

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High-frequency vs. conventional ventilation at the time of CDH repair is not associated with higher mortality and oxygen dependency: a retrospective cohort study

Cited by 11 publications

References 20 publications

Respiratory Support of Infants With Congenital Diaphragmatic Hernia

Respiratory Support of Infants With Congenital Diaphragmatic Hernia

Congenital diaphragmatic hernia survival in an English regional ECMO center

Diagnosis and management of congenital diaphragmatic hernia: a 2023 update from the Canadian Congenital Diaphragmatic Hernia Collaborative

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