High-frequency oscillatory ventilation versus conventional mechanical ventilation in congenital diaphragmatic hernia

Aims: Newborns affected by congenital diaphragmatic hernia (CDH) are high-r isk patients: today the mortality is still elevated and is essentially due to severe pulmonary hypoplasia, pulmonary hypertension and the absence of s urfactant. High-Frequency Oscillatory Ventilation (HFOV) seems to be a good pre- and postoperative technique in cases of CDH. Patients and Methods: We report our experience in the treatment of CDH; sin ce 1987 we have followed 44 patients. We divided them into two different gr oups in accordance with the Ventilation technique used: Group I (1987-1994) : 25 patients treated with conventional mechanical ventilation (CMV); Group II (1994-1997): 19 patients treated with HFOV used since the first day of life until clinical stabilisation and also prolonged during surgery and in the postoperative period. Results: 37 patients (84%) underwent surgery with closure of the diaphragma tic defect. We had a very good improvement in survival, rising from 67% (CM V) to 94% (HFOV) of the patients operated on, reaching an overall survival of 56% vs 79%. Conclusions: The use of HFOV for the treatment of CDH has proved to be a va luable technique for pre-operative stabilisation and for intra- and postope rative respiratory treatment, above all for newborns with CDH.