Continuous intrapulmonary distension with perfluorocarbon accelerates lunggrowth in infants with congenital diaphragmatic hernia: Initial experience

Background/Purpose: The authors have shown previously in an animal model th at neonatal lung growth can be accelerated by continuous intrapulmonary dis tension with a perfluorocarbon (PFC). The authors now describe a preliminar y clinical experience with this therapeutic concept in a select group of in fants with congenital diaphragmatic hernia (CDH). Methods: Neonates with very high predicted mortality rate caused by CDH had their lungs completely filled with PFC while on extracorporeal life suppor t (ECLS); (n = 5). A continuous positive pressure of 7 to 10 cm H2O was mai ntained via the endotracheal tube for 3 to 7 days (mean, 5.6 +/- 0.87 days) . The areas of both lungs (L) then were measured daily from digitized chest x-rays and divided by the area of the corresponding L1 vertebrae (V), to c reate an L/V index, so as to control for variable roentgenographic techniqu es. Immediately after removal of PFC, blood gas data were collected off ECL S. Results: At the end of continuous pulmonary distension, all patients showed improvements in oxygenation and ventilation. The ipsilateral lungs showed significant increase of the L/V index with time (P = .003) and of L/V's dai ly change (P < .0001), suggesting accelerated lung growth. Overall survival rate was 40% (2 of 5). Of the 3 patients that had 7 days of distension, 2 survived. Conclusions: Continuous intrapulmonary distension with PFC for up to 1 week accelerated ipsilateral lung growth, improved gas exchange, and increased survival of CDH infants with profound pulmonary hypoplasia marooned on ECLS . Additional trials of PFC-based pulmonary distension in similar infants ar e warranted. J Pediatr Surg 36:1237-1240. Copyright (C) 2001 by W.B. Saunde rs Company.