%0 Journal Article
%T Rescue High-Frequency Oscillatory Ventilation for Congenital Diaphragmatic Hernia: What about Lung Histopathology and Necropsy Findings?
%A Gustavo Rocha
%A Jorge Correia-Pinto
%A Herc¨ªlia Guimar£¿es
%J ISRN Critical Care
%D 2013
%R 10.5402/2013/857365
%X Introduction. It is not yet a resolved issue whether HFOV (high-frequency oscillatory ventilation), used as primary mode or as rescue ventilation, has benefit over conventional mechanical ventilation for CDH (congenital diaphragmatic hernia) patients treatment. Purpose. To evaluate the success rate of rescue HFOV for CDH, and the histological characteristics of the lungs, at the autopsy of the deceased patients. Material and Methods. Out of 80 CDH patients, 10 were treated with rescue HFOV. The success of HFOV, histological exam of the lungs of deceased patients, and data on the followup of discharged patients were assessed. Results. Rescue HFOV was started between two hours and four days of life. The success rate of rescue HFOV was 20% (2/10). Autopsy findings along with pulmonary hypoplasia included coarctation of aorta , pneumonia , meconium aspiration , hyaline membranes , severe muscular hypertrophy of medium and small diameter lung arteries , severe lung hypoplasia , pleural effusions , haemorrhagic diatesis , and signs of overwhelming sepsis . The five-years follow up of the two survivors revealed normal growth and neurodevelopment. Conclusions. The results of this study support the idea that rescue HFOV may increase survival of CDH patients, when conventional mechanical ventilation fails. 1. Introduction The underlying pathophysiology of Bochdalek congenital diaphragmatic hernia (CDH) is that of pulmonary insufficiency and persistent pulmonary hypertension secondary to pulmonary hypoplasia. The severity of CDH is related mostly to the degree of hypoplasia, which depends on the size of the defect, the presence of the liver in the chest, and how early in gestation the abdominal contents were displaced [1]. A standardized postnatal management of infants with CDH, the CDH EURO Consortium Consensus, has been proposed in 2010 [2]. The different centers treating CDH patients use different mechanical ventilation strategies, and most target the use of gentle ventilation and permissive hypercapnia. The actual recommendations include the use of high-frequency oscillatory ventilation (HFOV) if conventional mechanical ventilation (CMV) fails [3]. Although many centers use HFOV as the primary mode of ventilation, it is not yet a resolved issue whether this approach has benefit over CMV. The ongoing multicenter randomized controlled trial, VICI trial, will help to clarify which primary respiratory mode, CMV or HFOV, has the most benefit on CDH patients. Our center uses HFOV as a rescue ventilation mode for CDH patients. We conducted a study in order to
%U http://www.hindawi.com/journals/isrn.critical.care/2013/857365/