Tolazoline therapy for persistent pulmonary hypertension after congenital diaphragmatic hernia repair

Bloss, Robert S.; Türmen, Tomris; Beardmore, Harvey E.; Aranda, Jacob V.

doi:10.1016/s0022-3476(80)80441-0

Cited by 46 publications

(11 citation statements)

References 18 publications

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“…However, among live-born infants, prenatally diagnosed CDH (PD-CDH) is associated with a significantly lower survival rate (25-30%) for severe cases with PH and PPHN. There are reports of protocolized management (PM) for PD-CDH but its real advantages are controversial [7][8][9][10]. The aim of this study was to evaluate the efficacy of PM in patients with CDH.…”

Section: Introductionmentioning

confidence: 99%

Efficacy of protocolized management for congenital diaphragmatic hernia. A review of 100 cases

et al. 2006

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A review of 100 consecutive cases of congenital diaphragmatic hernia (CDH) treated at our institute focusing on the efficacy of protocolized management (PM) was conducted. Of the 100 cases, 14 who became symptomatic more than 24 h after birth, and seven with fatal anomalies (four cardiac and three chromosomal) were excluded, leaving 79 subjects for this study. Of these, 41 were diagnosed prenatally (PD). Subjects were divided into four groups. Group I: No PD, no PM (n = 34), Group II: No PD, PM (n = 4), Group III: PD, no PM (n = 21), and Group IV: PD, PM (n = 20). PM includes criteria for planned delivery, use of high frequency oxygenation, nitric oxide, echocardiography (EC), and a medication schedule. Overall survival rates for Groups I, II, III, and IV were 73.5% (25/34), 75% (3/4), 38.1% (8/21), and 70.0% (14/20), respectively. Survival rates were higher when PM was used: 70.8% (Groups II, IV) versus 60.0% (Groups I, III). Survival rates were significantly lower if diagnosed prenatally (PD+): 53.7% (Groups III, IV) versus 73.7% (Groups I, II) (P < 0.01). However, in PD+ groups, survival was significantly higher if PM was used (P < 0.05). PM significantly reduced length of hospital stay (35.5 vs. 52.0 days: P < 0.05). EC was found to be a predictor for survival while post-ductal AaDO(2) was not. In 17 cases with cardiac anomalies, PM did not affect survival. Our study suggests that use of PM for prenatally diagnosed CDH cases is associated with improved outcome, although the components of PM need to be tested in prospective trials to determine their true value.

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Section: Introductionmentioning

confidence: 99%

Efficacy of protocolized management for congenital diaphragmatic hernia. A review of 100 cases

et al. 2006

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“…6 A 'honeymoon' period postoperatively before the onset of PFC is well documented 7 and has been claimed to be a good prognostic factor in survival from PFC. 8 All patients in this study had stable postoperative to PFC periods, the shortest being three hours, but three patients had episodes occurring 6, 9 and 13 days postoperatively. This demonstrates the slow resolution of the vascular lability in PFC and emphasises the need for caution and persistent close observation in these patients.…”

Section: Discussionmentioning

confidence: 68%

Congenital Diaphragmatic Hernia and the Management of Persistent Foetal Circulation

1985

Anaesth Intensive Care

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Twenty-two cases of diaphragmatic hernia, presenting from 1978 to 1982, were reviewed. Sixteen patients presented before 24 hours of life, of whom nine survived (56%). Six were late presenters who all did well. Seven babies had ten documented episodes of persistent foetal circulation (PFC) occurring as early as three hours postoperatively, although three babies had episodes in their second week. Hyperventilation, with hand bagging, was successful in treating five out of six episodes of PFC (83%), without complication. Tolazoline caused improvement in two out of four episodes of PFC but was associated with significant complications. We recommend early and sometimes persistent use of hyperventilation by hand bagging as a means of managing PFC in diaphragmatic hernia.

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“…Ad. 4: Modulation of pulmonary vascular tone (Abman 1986, Abu-Osba 1992, Bloss 1980, Bosschetti 1985, Cassin 1987, Drummond 1981, Ein 1980, Friedman 1986, Hammerman 1987, Heymann 1989, lohns 1991, KätJrtJ 1985, Pepke-Zaba 1991, Stenmark 1983, Stevenson 1980, Turner 1984, Vanhoutte 1987.…”

Section: Tibboel Et Almentioning

confidence: 99%

"Changing concepts in the treatment of congenital diaphragmatic hernia"

et al. 1993

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Tolazoline therapy for persistent pulmonary hypertension after congenital diaphragmatic hernia repair

Cited by 46 publications

References 18 publications

Efficacy of protocolized management for congenital diaphragmatic hernia. A review of 100 cases

Efficacy of protocolized management for congenital diaphragmatic hernia. A review of 100 cases

Congenital Diaphragmatic Hernia and the Management of Persistent Foetal Circulation

"Changing concepts in the treatment of congenital diaphragmatic hernia"

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