Respiratory function testing for guiding ventilator mode conversion in congenital diaphragmatic hernia

Abstract

IntroductionFor patients with a congenital diaphragmatic hernia, conventional mechanical ventilation (CMV) and high‐frequency oscillatory ventilation (HFOV) are used in initial ventilatory management. HFOV has recently been recommended as a rescue therapy; however, we use HFOV for initial ventilation management, with a preoperative challenge test for CMV conversion and respiratory function testing at the time of CMV conversion. We aimed to compare patient characteristics between CMV conversion‐ and HFOV‐preferred treatment groups.MethodsVentilator settings and blood gases were retrospectively evaluated pre‐ and post‐CMV conversion, and respiratory function tests for compliance of the respiratory system (Crs) and for resistance of the respiratory system (Rrs) were performed during the trial to CMV conversion.ResultsNo differences were observed between the CMV conversion‐ and HFOV‐preferred groups regarding gestational age, birth weight, and observed/expected lung area‐to‐head circumference ratios. The median Crs (ml/cmH2O/kg) and Rrs (cmH2O･kg/L/s) in the CMV conversion‐ and HFOV‐preferred groups was 0.42 versus 0.53 (p = .44) and 467 versus 327 (p = .045), respectively. The pre and posttrial amount of change in blood gas levels and ventilator parameters in the CMV conversion‐ and HFOV‐preferred groups were as follows: mean airway pressure, −2.0 versus 0 cmH2O; partial pressure of carbon dioxide, 6.1 versus 2.9 Torr; alveolar‐arterial oxygen difference, −39.5 versus −50 Torr; and oxygenation index, −1.0 versus −0.6; respectively.ConclusionRespiratory function tests were useful in tailoring ventilator settings. Patients with high Rrs values responded better to CMV conversion.