Perioperative Improvement in Pulmonary Function in Infants with Congenital Diaphragmatic Hernia - 15/03/23
, Brian K. Jordan, MD, PhD, Kseniya Parkhotyuk, RRT, Diane Schilling, RRT, Cindy T. McEvoy, MD, MCRAbstract |
Objective |
The objective of this study was to compare serial changes in pulmonary function in contemporary infants with congenital diaphragmatic hernia managed with a gentle ventilation approach.
Study design |
Observational cohort, single-center study of infants ≥350/7 weeks gestation at delivery with congenital diaphragmatic hernia. Functional residual capacity (FRC), passive respiratory compliance, and passive respiratory resistance were measured presurgical and postsurgical repair and within 2 weeks of discharge. A 1-way analysis of variance for repeated measures was used to evaluate the change in FRC, passive respiratory compliance, and passive respiratory resistance over these repeated measures.
Results |
Twenty-eight infants were included in the analysis with a mean gestational age of 38.3 weeks and birth weight of 3139 g. We found a significant increase in FRC across the 3 time points (mean in mL/kg [SD]: 10.9 [3.6] to 18.5 [5.2] to 24.2 [4.4]; P < .0001). There was also a significant increase in passive respiratory compliance and decrease in passive respiratory resistance. In contrast to a previous report, there were survivors in the current cohort with a preoperative FRC of <9 mL/kg. The mean FRC measured at discharge was in the range considered within normal limits. Sixteen infants had prenatal measurements of the lung-to-head ratio, but there was no relationship between the lung-to-head ratio and preoperative or postoperative FRC measurements.
Conclusions |
Infants with congenital diaphragmatic hernia demonstrate significant increases in FRC and improvements in respiratory mechanics measured preoperatively and postoperatively and at discharge. We speculate these improvements are due to the surgical resolution of the mechanical obstruction to lung recruitment and that after achieving preoperative stability, repair should not be delayed given these demonstrable postoperative improvements.
Le texte complet de cet article est disponible en PDF.Abbreviations : CDH, Crs, ECMO, FRC, LHR, MRI, O:E, PEEP, PFT, RCT, RDS
Plan
| This work was supported by the NIH National Heart Lung Blood Institute K23 HL144918 (B.K.J), NIH R01 HL105447 with co-funding from the Office of Dietary Supplement; the National Center for Advancing Translational Sciences of the National Institutes of Health UL1TR000128, NIH UH3OD023288, from the Environmental influences on Child Health Outcomes Program (ECHO) NIH R33HL147906, and the American Lung Association (C.M.). The funders had no role in study design, data collection, analysis, decision to publish, or preparation of the manuscript. The authors declare no conflicts of interest. |
Vol 253
P. 173 - février 2023 Retour au numéro
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