Highlights
- •What is currently known? Lung protective strategies for CDH include high frequency ventilation (both HFOV and HFJV) used primarily as rescue for patients failing to achieve ventilatory targets on CMV. There is little evidence of effectiveness of high frequency ventilation as a primary support mode in CDH.
- •What information is contained in this article? This article reports the largest experience to date with HFJV as a primary ventilatory mode in high risk CDH.
Summary
Background
The optimal role of high frequency jet ventilation (HFJV) in lung protective stabilization
of congenital diaphragmatic hernia (CDH) remains uncertain. We aimed to describe our
center’s experience with HFJV as both a rescue (following failed stabilization with
CMV) and primary ventilation mode in the management of CDH.
Methods
Liveborn CDH patients treated from 2013- 2021 in a single institution were reviewed.
We compared 3 groups based on their primary and last ventilation mode prior to surgery:
CMV (Group 1); HFJV (Group 2); and CMV/HFJV (Group 3). Outcomes included a composite
primary outcome (>1 of mortality, need for ECMO or need for supplemental O2 at discharge), total invasive
ventilation days and development of pneumothorax. A descriptive analysis including
univariate group comparisons was performed. Multivariate logistic regression models
investigating the relationship between mode of ventilation and the primary outcome
adjusted by potentially confounding covariates were constructed.
Results
56 patients (32 Group 1, 18 Group 2, 6 Group 3) were analyzed. Group 2 and 3 patients
had more severe disease based on liver position, SNAP-II score, pulmonary hypertension
severity, need for inotropic support, CDHSG defect size and need for patch repair.
There were no group differences in survival, need for ECMO, or pneumothorax occurrence,
although infants receiving HFJV required longer invasive ventilation and had a greater
need for O2 at discharge. Multivariate logistic regression revealed no associations
between mode of ventilation and outcome.
Conclusions
HFJV appears effective, both for CMV rescue and as a primary ventilation strategy
in high risk CDH.
Keywords
Abbreviations:
bronchopulmonary dysplasia (BPD) (congenital diaphragmatic hernia (CDH)), conventional mechanical ventilation (CMV) (extracorporeal membrane oxygenation (ECMO)), high frequency jet ventilation (HFJV) (high frequency oscillatory ventilation (HFOV)), inspiratory to expiratory (I:E) (inspiratory time (I-time)), mean airway pressure (MAP) (peak end expiratory pressure (PEEP)), peak inspiratory pressure (PIP) (Score for Acute Neonatal Physiology version II (SNAP-II))To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of Pediatric SurgeryAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Preoperative Management of Congenital Diaphragmatic Hernia.Curr Treat Options Peds. 2022; https://doi.org/10.1007/s40746-022-00246-x
- A definition of gentle ventilation in congenital diaphragmatic hernia: a survey of neonatologists and pediatric surgeons.J Perinat Med. 2017 Dec 20; 45: 1031-1038
- Australian and New Zealand Neonatal Network. Trends in use and outcome of newborn infants treated with high frequency ventilation in Australia and New Zealand, 1996-2003.J Paediatr Child Health. 2007 Mar; 43: 160-166
- The impact of changing neonatal respiratory management on extracorporeal membrane oxygenation utilization.J Pediatr Surg. 2002 May; 37: 703-705
- Prognosis of conventional vs. high-frequency ventilation for congenital diaphragmatic hernia: a retrospective cohort study.J Perinatol. 2021 Apr; 41: 814-823
- Conventional Mechanical Ventilation Versus High-frequency Oscillatory Ventilation for Congenital Diaphragmatic Hernia: A Randomized Clinical Trial (The VICI-trial).Ann Surg. 2016 May; 263: 867-874
- Diagnosis and management of congenital diaphragmatic hernia: a clinical practice guideline.CMAJ. 2018 Jan 29; 190: E103-E112
- Management of infants with severe respiratory failure and persistence of the fetal circulation.without hyperventilation. Pediatrics. 1985 Oct; 76: 488-494
- Congenital diaphragmatic hernia: survival treated with very delayed surgery, spontaneous respiration, and no chest tube.J Pediatr Surg. 1995 Mar; 30: 406-409
- An observational, prospective, multicenter study on rescue high-frequency oscillatory ventilation in neonates failing with conventional ventilation.PLoS One. 2019 Jun 10; 14e0217768
- Rescue high frequency ventilation for congenital diaphragmatic hernia.J Neonatal Perinatal Med. 2019; 12: 173-178
- Rescue ventilation with high frequency oscillation in premature baboons with hyaline membrane disease.Pediatr Pulmonol. 1992 Jan; 12: 29-36
- Elective high frequency oscillatory ventilation versus conventional ventilation for acute pulmonary dysfunction in preterm infants.Cochrane Database Syst Rev. 2015; 3 (Mar 19) (doi(3):CD000104): CD000104
- High-Frequency Jet Ventilation in Neonatal and Pediatric Subjects: A Narrative Review.Respir Care. 2021 May; 66: 845-856
- Preliminary observations of the use of high-frequency jet ventilation as rescue therapy in infants with congenital diaphragmatic hernia.J Pediatr Surg. 2010 Apr; 45: 698-702
- High Frequency Jet Ventilation during Initial Management, Stabilization, and Transport of Newborn Infants with Congenital Diaphragmatic Hernia: A Case Series.Crit Care Res Pract. 2013; 2013937871
- Prediction of ECMO and Mortality in Neonates with Congenital Diaphragmatic Hernia Using the SNAP-II Score.Klin Padiatr. 2019 Nov; 231: 297-303
Article info
Publication history
Accepted:
January 3,
2023
Received:
January 2,
2023
Publication stage
In Press Accepted ManuscriptIdentification
Copyright
© 2023 Elsevier Inc. All rights reserved.
