PREOPERATIVE STABILIZATION USING HIGH-FREQUENCY OSCILLATORY VENTILATION IN THE MANAGEMENT OF CONGENITAL DIAPHRAGMATIC-HERNIA

Objectives: a) To assess the efficiency of preoperative stabilization with the use of high-frequency oscillatory ventilation in the treatmen t of congenital diaphragmatic hernia; b) to determine early prognosis factors. Design: Prospective, consecutive patient study. Setting: A te rtiary neonatal intensive care unit in a university hospital. Patients : Ah patients admitted to the neonatal intensive care unit with a diag nosis of congenital diaphragmatic hernia between April 1990 and June 1 993 (n = 18). Interventions: None. Measurements and Main Results: Elev en infants had an antenatal diagnosis. Ventilatory settings, blood gas values, arterial-alveolar oxygen ratio, and oxygenation index were re corded on admission and every 3 hrs thereafter until surgery. Surgery was performed if the FIO2, was <0.3 and mean airway pressure was simil ar to 9 cm H2O, while the infants were ventilated with high-frequency oscillation. Mean duration of high-frequency oscillatory ventilation w as 57 +/- 52 hrs before surgery and 60 +/- 104 hrs after surgery. Over all survival rate was 72%. Infants were divided into two groups, accor ding to the time of surgery. Group 1 (n = 12) patients were operated o n in the first 48 hrs of life; on admission,; all group 1 patients had an arterial-alveolar oxygen ratio of greater than or equal to 0.3 and an oxygenation index of less than or equal to 10, and all recovered. Group 2 (n = 6) consisted of patients for whom preoperative stabilizat ion was difficult to achieve. One infant died before surgery. Four oth er infants had congenital malformations and subsequently died. Only on e infant survived. In this group, the arterial-alveolar oxygen ratio a nd oxygenation index on admission were 0.08 +/- 0.05 and 33.2 +/- 14.6 , respectively (p < .01 vs. group 1). Conclusions: a) This study demon strated the efficiency of preoperative stabilization using high-freque ncy oscillation in the treatment of congenital diaphragmatic hernia. b ) An arterial-alveolar oxygen ratio of greater than or equal to 0.3 an d an oxygenation index of less than or equal to 10 on admission are as sociated with a rapidly completed surgical procedure and a good outcom e.