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High Frequency Jet Ventilation during Initial Management, Stabilization, and Transport of Newborn Infants with Congenital Diaphragmatic Hernia: A Case Series

DOI: 10.1155/2013/937871

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Objective. To review experience of the transport and stabilization of infants with CDH who were treated with high frequency jet ventilation (HFJV). Study Design. Retrospective chart review was performed of infants with antenatal diagnosis of CDH born between 2004 and 2009, at Mount Sinai Hospital Toronto, Ontario, Canada. Detailed information was abstracted from the charts of all infants who received HFJV. Results. Of the 55 infants, 25 were managed with HFJV at some point during resuscitation and stabilization prior to transport. HFJV was the initial ventilation mode in six cases and nineteen infants were placed on HFJV as rescue therapy. Blood gases procured from the umbilical artery before and/or after the initiation of HFJV. There was a significant difference detected for both PaCO2 ( ) and pH ( ). The pre- and posttransport vital signs remained stable and no transport related deaths or significant complications occurred. Conclusion. HFJV appears to be safe and effective providing high frequency rescue therapy for infants with CDH failing conventional mechanical ventilation. This paper supports the decision to utilize HFJV as it likely contributed to safe transport of many infants that would not otherwise have tolerated transport to a surgical centre. 1. Introduction Congenital diaphragmatic hernia (CDH) is one of the most challenging malformations that neonatologists and pediatric surgeons must manage [1, 2]. In patients with antenatally diagnosed CDH, the prognosis is dependent on both the degree of lung hypoplasia and persistent pulmonary hypertension (PPHN) after their birth [1, 3]. The care of these infants has seen significant evolution, from previous aggressive ventilation and emergent surgical repair to current physiologic stabilization, standardized management protocols, gentle ventilation strategies, and delayed surgical repair, all in less than two decades [2]. Survival of patients with CDH is dependent on early diagnosis and improved resuscitation and transportation of an optimally-supported baby to a major surgical center for repair [3–5]. Infants with CDH may be diagnosed antenatally and deliver at a high risk perinatal center. Most infants with CDH require respiratory support with set limits on ventilatory pressures to avoid lung overdistension and acceptance of adequate rather than optimal PaCO2 and PaO2 [1]. High-frequency ventilation (HFV) allows gas exchange at low volumes thereby decreasing iatrogenic pulmonary barotrauma [6]. To date two modes of HFV has been studied in the care of infants with CDH: high frequency oscillatory


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