PARTIAL LIQUID VENTILATION AND NITRIC-OXIDE IN CONGENITAL DIAPHRAGMATIC-HERNIA

Purpose: In congenital diaphragmatic hernia (CDH) there is immature lu ng development with a resulting clinical picture of pulmonary hypoplas ia, surfactant deficiency, and pulmonary hypertension. Pulmonary hypop lasia and surfactant deficiency both have been successfully treated us ing partial liquid ventilation (PLV). Pulmonary hypertension associate d with CDH has proven difficult to treat, but inhaled nitric oxide, wh ich is a potent highly selective pulmonary vasodilator, may have poten tial. The aim of this study was to assess PLV in CDH and to document t he effect of nitric oxide when administered through perfluorocarbon. M ethods: This study using the lamb CDH model consisted of two groups; a conventional mechanically ventilated (CMV) group and a PLV group. At 1 and 3 hours, nitric oxide (80 ppm) was given for 15 minutes. Data co llected included blood gases, pulmonary function tests, pulmonary and systemic blood pressure. Results: After 30 minutes of ventilation, blo od gases in the PLV group were all significantly improved (P < .001): pH, CMV 6.92 +/- 0.15 versus PLV 7.24 +/- 0.11; PCO2, CMV 139 +/- 26 m mHg versus PLV 52 +/- 11 mmHg; PO2, CMV 26 +/- 15 mmHg versus PLV 184 +/- 60 mmHg. In addition, there was a significant increase in dynamic compliance and a reduction in pulmonary hypertension. Nitric oxide was only efficacious in the PLV group, causing a further increase in oxyg enation and a decrease in pulmonary hypertension. These effects were r eversed when the nitric oxide was stopped. Conclusion:This study shows that PLV both improves gas exchange and pulmonary mechanics in CDH an d allows the effective delivery of nitric oxide to reduce the pulmonar y hypertension associated with CDH. Copyright (C) 1997 by W.B. Saunder s Company.