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Congenital diaphragmatic hernia in 120 infants treated consecutively with permissive hypercapnea/spontaneous respiration/elective repair
Background/Purpose: Poor prognosis (approximately 50% survival rate and significant morbidity) traditionally has been associated with congenital diaphragmatic hernia (CDH). The authors reviewed a single institution experience and challenged conventional wisdom in the context of a care strategy based...
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Published in: | Journal of pediatric surgery 2002-03, Vol.37 (3), p.357-366 |
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creator | Boloker, Judd Bateman, David A. Wung, Jen-Tien Stolar, Charles J.H. |
description | Background/Purpose: Poor prognosis (approximately 50% survival rate and significant morbidity) traditionally has been associated with congenital diaphragmatic hernia (CDH). The authors reviewed a single institution experience and challenged conventional wisdom in the context of a care strategy based on permissive hypercapnea/spontaneous respiration/elective repair.
Methods: From August 1992 through February 2000, all infants with CDH and (1) respiratory distress requiring mechanical ventilation, (2) in-born or (3) transferred preoperatively within hours of birth are reported. All respiratory care strategy used permissive hypercapnea/spontaneous respiration and combined with elective repair. Arterial blood gas values and concomitant ventilator support were recorded. Outcome markers were (1) need for extracorporeal membrane oxygenation ECMO, (2) discharge to home, (3) supplemental oxygen need at discharge, and (4) influence of non-ECMO ancillary therapies (surfactant, nitric oxide, high-frequency oscillatory ventilation).
Results: One hundred twenty consecutive infants were reviewed. Overall survival rate was 75.8%, but, excluding 18 of 120 not treated (6 lethal anomalies, 10 overwhelming pulmonary hypoplasia, 3 prerepair ECMO-related neurocomplications), 84.4% survived to discharge. A total of 67/120 were inborn. Non-ECMO ancillary treatments had no impact on survival rate. ECMO was used in 13.3%. Surgery was transabdominal; prosthetics were used in 7%. Tube thoracostomy was rare. Every inborn patient (n = 11) requiring a chest tube for pneumothorax died. Respiratory support before surgery was peak inspiratory pressure (PIP), 22, F
IO
2, .43 with Pa
O
2, 66 torr; Pa
CO
2, 41 torr; and pH, 7.32. The survivors discharged on oxygen (n = 2) died at 4 and 7 months.
Conclusions: The majority of infants with life-threatening CDH treated with permissive hypercapnea/spontaneous respiration/elective surgery survive to discharge with minimal pulmonary morbidity. |
doi_str_mv | 10.1053/jpsu.2002.30834 |
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Methods: From August 1992 through February 2000, all infants with CDH and (1) respiratory distress requiring mechanical ventilation, (2) in-born or (3) transferred preoperatively within hours of birth are reported. All respiratory care strategy used permissive hypercapnea/spontaneous respiration and combined with elective repair. Arterial blood gas values and concomitant ventilator support were recorded. Outcome markers were (1) need for extracorporeal membrane oxygenation ECMO, (2) discharge to home, (3) supplemental oxygen need at discharge, and (4) influence of non-ECMO ancillary therapies (surfactant, nitric oxide, high-frequency oscillatory ventilation).
Results: One hundred twenty consecutive infants were reviewed. Overall survival rate was 75.8%, but, excluding 18 of 120 not treated (6 lethal anomalies, 10 overwhelming pulmonary hypoplasia, 3 prerepair ECMO-related neurocomplications), 84.4% survived to discharge. A total of 67/120 were inborn. Non-ECMO ancillary treatments had no impact on survival rate. ECMO was used in 13.3%. Surgery was transabdominal; prosthetics were used in 7%. Tube thoracostomy was rare. Every inborn patient (n = 11) requiring a chest tube for pneumothorax died. Respiratory support before surgery was peak inspiratory pressure (PIP), 22, F
IO
2, .43 with Pa
O
2, 66 torr; Pa
CO
2, 41 torr; and pH, 7.32. The survivors discharged on oxygen (n = 2) died at 4 and 7 months.
Conclusions: The majority of infants with life-threatening CDH treated with permissive hypercapnea/spontaneous respiration/elective surgery survive to discharge with minimal pulmonary morbidity.</description><identifier>ISSN: 0022-3468</identifier><identifier>EISSN: 1531-5037</identifier><identifier>DOI: 10.1053/jpsu.2002.30834</identifier><identifier>PMID: 11877648</identifier><identifier>CODEN: JPDSA3</identifier><language>eng</language><publisher>Philadelphia, PA: Elsevier Inc</publisher><subject>Biological and medical sciences ; Blood Gas Analysis ; Chest Tubes ; Elective Surgical Procedures - methods ; Extracorporeal Membrane Oxygenation - methods ; Genetic Diseases, Inborn - mortality ; Genetic Diseases, Inborn - surgery ; Hernia, Diaphragmatic - mortality ; Hernia, Diaphragmatic - surgery ; Hernias, Diaphragmatic, Congenital ; Humans ; Hypercapnia - surgery ; Infant, Newborn ; Infant, Newborn, Diseases - mortality ; Infant, Newborn, Diseases - surgery ; Intubation - methods ; Medical sciences ; Oxygen Consumption - physiology ; Pneumology ; Pneumothorax - genetics ; Pneumothorax - mortality ; Pneumothorax - therapy ; Positive-Pressure Respiration - methods ; Postoperative Care - methods ; Preoperative Care - methods ; Respiratory Mechanics - physiology ; Respiratory system : syndromes and miscellaneous diseases ; Risk Factors ; Survival Rate</subject><ispartof>Journal of pediatric surgery, 2002-03, Vol.37 (3), p.357-366</ispartof><rights>2002 Elsevier Science (USA)</rights><rights>2002 INIST-CNRS</rights><rights>Copyright 2002 by W.B. Saunders Company.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c373t-e72383e33838fe5e925852d75a9c31e7159e0e4e0dc99f11b5a64adb72282ad3</citedby></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>309,310,314,780,784,789,790,23930,23931,25140,27924,27925</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=13524450$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/11877648$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Boloker, Judd</creatorcontrib><creatorcontrib>Bateman, David A.</creatorcontrib><creatorcontrib>Wung, Jen-Tien</creatorcontrib><creatorcontrib>Stolar, Charles J.H.</creatorcontrib><title>Congenital diaphragmatic hernia in 120 infants treated consecutively with permissive hypercapnea/spontaneous respiration/elective repair</title><title>Journal of pediatric surgery</title><addtitle>J Pediatr Surg</addtitle><description>Background/Purpose: Poor prognosis (approximately 50% survival rate and significant morbidity) traditionally has been associated with congenital diaphragmatic hernia (CDH). The authors reviewed a single institution experience and challenged conventional wisdom in the context of a care strategy based on permissive hypercapnea/spontaneous respiration/elective repair.
Methods: From August 1992 through February 2000, all infants with CDH and (1) respiratory distress requiring mechanical ventilation, (2) in-born or (3) transferred preoperatively within hours of birth are reported. All respiratory care strategy used permissive hypercapnea/spontaneous respiration and combined with elective repair. Arterial blood gas values and concomitant ventilator support were recorded. Outcome markers were (1) need for extracorporeal membrane oxygenation ECMO, (2) discharge to home, (3) supplemental oxygen need at discharge, and (4) influence of non-ECMO ancillary therapies (surfactant, nitric oxide, high-frequency oscillatory ventilation).
Results: One hundred twenty consecutive infants were reviewed. Overall survival rate was 75.8%, but, excluding 18 of 120 not treated (6 lethal anomalies, 10 overwhelming pulmonary hypoplasia, 3 prerepair ECMO-related neurocomplications), 84.4% survived to discharge. A total of 67/120 were inborn. Non-ECMO ancillary treatments had no impact on survival rate. ECMO was used in 13.3%. Surgery was transabdominal; prosthetics were used in 7%. Tube thoracostomy was rare. Every inborn patient (n = 11) requiring a chest tube for pneumothorax died. Respiratory support before surgery was peak inspiratory pressure (PIP), 22, F
IO
2, .43 with Pa
O
2, 66 torr; Pa
CO
2, 41 torr; and pH, 7.32. The survivors discharged on oxygen (n = 2) died at 4 and 7 months.
Conclusions: The majority of infants with life-threatening CDH treated with permissive hypercapnea/spontaneous respiration/elective surgery survive to discharge with minimal pulmonary morbidity.</description><subject>Biological and medical sciences</subject><subject>Blood Gas Analysis</subject><subject>Chest Tubes</subject><subject>Elective Surgical Procedures - methods</subject><subject>Extracorporeal Membrane Oxygenation - methods</subject><subject>Genetic Diseases, Inborn - mortality</subject><subject>Genetic Diseases, Inborn - surgery</subject><subject>Hernia, Diaphragmatic - mortality</subject><subject>Hernia, Diaphragmatic - surgery</subject><subject>Hernias, Diaphragmatic, Congenital</subject><subject>Humans</subject><subject>Hypercapnia - surgery</subject><subject>Infant, Newborn</subject><subject>Infant, Newborn, Diseases - mortality</subject><subject>Infant, Newborn, Diseases - surgery</subject><subject>Intubation - methods</subject><subject>Medical sciences</subject><subject>Oxygen Consumption - physiology</subject><subject>Pneumology</subject><subject>Pneumothorax - genetics</subject><subject>Pneumothorax - mortality</subject><subject>Pneumothorax - therapy</subject><subject>Positive-Pressure Respiration - methods</subject><subject>Postoperative Care - methods</subject><subject>Preoperative Care - methods</subject><subject>Respiratory Mechanics - physiology</subject><subject>Respiratory system : syndromes and miscellaneous diseases</subject><subject>Risk Factors</subject><subject>Survival Rate</subject><issn>0022-3468</issn><issn>1531-5037</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2002</creationdate><recordtype>article</recordtype><recordid>eNp1kEtvEzEURi0EoqHtmh3yhu4m8TOeWaIIClIlNt1bN_adxtXEM9ieovwDfjYeEqkrNr7yp3MfOoR85GzNmZab5ynPa8GYWEvWSvWGrLiWvNFMmrdkVXPRSLVtr8iHnJ8ZqzHj78kV560xW9WuyJ_dGJ8whgID9QGmQ4KnI5Tg6AFTDEBDpFywWnqIJdOSEAp66saY0c0lvOBwor9DOdAJ0zHkXBN6ONWPgykibPI0xgIRxznThHkKqY4f4wYHdEt7DScI6Ya862HIeHup1-Tx29fH3ffm4ef9j92Xh8ZJI0uDRshWoqxP26PGTuhWC280dE5yNFx3yFAh867res73GrYK_N4I0Qrw8prcncdOafw1Yy623uxwGM4XWsNVx1XLKrg5gy6NOSfs7ZTCEdLJcmYX93Zxbxf39p_72vHpMnreH9G_8hfZFfh8ASA7GPoE0YX8ykktlNLL6u7MYfXwEjDZ7AJGhz6k6sz6Mfz3iL-XS6Qq</recordid><startdate>20020301</startdate><enddate>20020301</enddate><creator>Boloker, Judd</creator><creator>Bateman, David A.</creator><creator>Wung, Jen-Tien</creator><creator>Stolar, Charles J.H.</creator><general>Elsevier Inc</general><general>Elsevier</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20020301</creationdate><title>Congenital diaphragmatic hernia in 120 infants treated consecutively with permissive hypercapnea/spontaneous respiration/elective repair</title><author>Boloker, Judd ; Bateman, David A. ; Wung, Jen-Tien ; Stolar, Charles J.H.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c373t-e72383e33838fe5e925852d75a9c31e7159e0e4e0dc99f11b5a64adb72282ad3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2002</creationdate><topic>Biological and medical sciences</topic><topic>Blood Gas Analysis</topic><topic>Chest Tubes</topic><topic>Elective Surgical Procedures - methods</topic><topic>Extracorporeal Membrane Oxygenation - methods</topic><topic>Genetic Diseases, Inborn - mortality</topic><topic>Genetic Diseases, Inborn - surgery</topic><topic>Hernia, Diaphragmatic - mortality</topic><topic>Hernia, Diaphragmatic - surgery</topic><topic>Hernias, Diaphragmatic, Congenital</topic><topic>Humans</topic><topic>Hypercapnia - surgery</topic><topic>Infant, Newborn</topic><topic>Infant, Newborn, Diseases - mortality</topic><topic>Infant, Newborn, Diseases - surgery</topic><topic>Intubation - methods</topic><topic>Medical sciences</topic><topic>Oxygen Consumption - physiology</topic><topic>Pneumology</topic><topic>Pneumothorax - genetics</topic><topic>Pneumothorax - mortality</topic><topic>Pneumothorax - therapy</topic><topic>Positive-Pressure Respiration - methods</topic><topic>Postoperative Care - methods</topic><topic>Preoperative Care - methods</topic><topic>Respiratory Mechanics - physiology</topic><topic>Respiratory system : syndromes and miscellaneous diseases</topic><topic>Risk Factors</topic><topic>Survival Rate</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Boloker, Judd</creatorcontrib><creatorcontrib>Bateman, David A.</creatorcontrib><creatorcontrib>Wung, Jen-Tien</creatorcontrib><creatorcontrib>Stolar, Charles J.H.</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of pediatric surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Boloker, Judd</au><au>Bateman, David A.</au><au>Wung, Jen-Tien</au><au>Stolar, Charles J.H.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Congenital diaphragmatic hernia in 120 infants treated consecutively with permissive hypercapnea/spontaneous respiration/elective repair</atitle><jtitle>Journal of pediatric surgery</jtitle><addtitle>J Pediatr Surg</addtitle><date>2002-03-01</date><risdate>2002</risdate><volume>37</volume><issue>3</issue><spage>357</spage><epage>366</epage><pages>357-366</pages><issn>0022-3468</issn><eissn>1531-5037</eissn><coden>JPDSA3</coden><abstract>Background/Purpose: Poor prognosis (approximately 50% survival rate and significant morbidity) traditionally has been associated with congenital diaphragmatic hernia (CDH). The authors reviewed a single institution experience and challenged conventional wisdom in the context of a care strategy based on permissive hypercapnea/spontaneous respiration/elective repair.
Methods: From August 1992 through February 2000, all infants with CDH and (1) respiratory distress requiring mechanical ventilation, (2) in-born or (3) transferred preoperatively within hours of birth are reported. All respiratory care strategy used permissive hypercapnea/spontaneous respiration and combined with elective repair. Arterial blood gas values and concomitant ventilator support were recorded. Outcome markers were (1) need for extracorporeal membrane oxygenation ECMO, (2) discharge to home, (3) supplemental oxygen need at discharge, and (4) influence of non-ECMO ancillary therapies (surfactant, nitric oxide, high-frequency oscillatory ventilation).
Results: One hundred twenty consecutive infants were reviewed. Overall survival rate was 75.8%, but, excluding 18 of 120 not treated (6 lethal anomalies, 10 overwhelming pulmonary hypoplasia, 3 prerepair ECMO-related neurocomplications), 84.4% survived to discharge. A total of 67/120 were inborn. Non-ECMO ancillary treatments had no impact on survival rate. ECMO was used in 13.3%. Surgery was transabdominal; prosthetics were used in 7%. Tube thoracostomy was rare. Every inborn patient (n = 11) requiring a chest tube for pneumothorax died. Respiratory support before surgery was peak inspiratory pressure (PIP), 22, F
IO
2, .43 with Pa
O
2, 66 torr; Pa
CO
2, 41 torr; and pH, 7.32. The survivors discharged on oxygen (n = 2) died at 4 and 7 months.
Conclusions: The majority of infants with life-threatening CDH treated with permissive hypercapnea/spontaneous respiration/elective surgery survive to discharge with minimal pulmonary morbidity.</abstract><cop>Philadelphia, PA</cop><pub>Elsevier Inc</pub><pmid>11877648</pmid><doi>10.1053/jpsu.2002.30834</doi><tpages>10</tpages></addata></record> |
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subjects | Biological and medical sciences Blood Gas Analysis Chest Tubes Elective Surgical Procedures - methods Extracorporeal Membrane Oxygenation - methods Genetic Diseases, Inborn - mortality Genetic Diseases, Inborn - surgery Hernia, Diaphragmatic - mortality Hernia, Diaphragmatic - surgery Hernias, Diaphragmatic, Congenital Humans Hypercapnia - surgery Infant, Newborn Infant, Newborn, Diseases - mortality Infant, Newborn, Diseases - surgery Intubation - methods Medical sciences Oxygen Consumption - physiology Pneumology Pneumothorax - genetics Pneumothorax - mortality Pneumothorax - therapy Positive-Pressure Respiration - methods Postoperative Care - methods Preoperative Care - methods Respiratory Mechanics - physiology Respiratory system : syndromes and miscellaneous diseases Risk Factors Survival Rate |
title | Congenital diaphragmatic hernia in 120 infants treated consecutively with permissive hypercapnea/spontaneous respiration/elective repair |
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