Mechanical ventilation strategies in the management of congenital diaphragmatic hernia

J. Wells Logan, C. Michael Cotten, Ronald N. Goldberg, Reese H. Clark

Research output: Contribution to journalArticlepeer-review

64 Scopus citations

Abstract

Most infants with congenital diaphragmatic hernia (CDH) require respiratory support. The goal of this report is to present an overview of mechanical ventilation strategies in the management of infants with CDH. The anatomic and physiologic limitations in the lungs of infants with diaphragmatic hernia make decisions on the best strategy and use of mechanical ventilation challenging. We will briefly review lung development in infants with CDH, identifying factors that provide a basis for lung protection strategies. Background on the use of specific mechanical ventilation modes and the rationale for each are provided. Finally, we review mechanical ventilation practices described in published case series of successful CDH management, with a brief review of additional treatments, including inhaled nitric oxide and extracorporeal membrane oxygenation. Although details of a single specific best strategy for mechanical ventilation for CDH infants cannot be identified from current literature, a lung protection ventilation approach, regardless of the device used, appears to reduce mortality risk.

Original languageEnglish (US)
Pages (from-to)115-125
Number of pages11
JournalSeminars in Pediatric Surgery
Volume16
Issue number2
DOIs
StatePublished - May 1 2007

Keywords

  • Congenital diaphragmatic hernia
  • Lung hypoplasia
  • Mechanical ventilation
  • Permissive hypercapnia
  • Pulmonary hypertension
  • Ventilator-induced lung injury

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Surgery

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