Conventional Mechanical Ventilation Versus High-frequency Oscillatory Ventilation for Congenital Diaphragmatic Hernia

Snoek, Kitty G.; Capolupo, Irma; Rosmalen, Joost van; Hout, Lieke de Jongste-van den; Vijfhuize, Sanne; Greenough, Anne; Wijnen, René; Tibboel, Dick; Reiss, Irwin; Pede, Alessandra Di; Dotta, Andrea; Bagolan, Pietro; Kraemer, Ulrike; Pinto, Carla; Silva, Maria Gorett; Saldanha, Joana; Bhat, Prashanth; Murthy, Vadivelam; Heijst, Arno van; Schaible, Thomas; Wessel, Lucas; Allegaert, Karel; Debeer, Anne

doi:10.1097/sla.0000000000001533

Cited by 229 publications

(155 citation statements)

References 31 publications

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“…48 The recently published VICI trial failed to show any difference in CDH outcome between extracorporeal life support and non-extracorporeal life support centres. 27 Current extracorporeal life support practice patterns in Canada show very low rates of use compared with the United States and Europe, yet CDH outcomes across Canada are comparable with those of published international reports. [49][50][51] Extracorporeal life support should be discussed during prenatal counselling and may be considered as a therapeutic rescue option in those centres that offer it.…”

Section: In Circumstances Where Extracorporeal Life Support Is Considsupporting

confidence: 64%

“…27 This study showed similar rates of mortality and bronchopulmonary dysplasia, the primary study outcome, between groups with conventional mechanical ventilation and groups with high-frequency oscillatory ventilation. Infants who were managed with conventional mechanical ventilation also had shorter durations of ventilation, reduced inotrope requirements and lower rates of extracorporeal life support.…”

Section: B-nr)mentioning

confidence: 67%

See 1 more Smart Citation

Diagnosis and management of congenital diaphragmatic hernia: a clinical practice guideline

Puligandla¹,

Skarsgard²,

Offringa³

et al. 2018

CMAJ

193

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Section: In Circumstances Where Extracorporeal Life Support Is Considsupporting

confidence: 64%

Section: B-nr)mentioning

confidence: 67%

Diagnosis and management of congenital diaphragmatic hernia: a clinical practice guideline

Puligandla¹,

Skarsgard²,

Offringa³

et al. 2018

CMAJ

193

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“…The optimal initial ventilation strategy was investigated in a collaborative initiative from the CDH EURO Consortium (VICI-trial, NTR 1310) [30]. Although the primary outcome (death/bronchopulmonary dysplasia at day 28) was not significantly different between the two groups, it was found that infants initially ventilated by conventional mechanical ventilation required a significantly shorter duration of ventilation, had less need for inhaled nitric oxide (iNO) or sildenafil, had a shorter duration of vasoactive medication and were less likely to require ECMO [3]. Therefore, the CDH EURO Consortium recommends conventional mechanical ventilation as the initial ventilation strategy.…”

Section: Resultsmentioning

confidence: 99%

“…Differences in opinion were primarily discussed between the five experts until full consensus was reached, and thereafter consensus was reached between all participating centers. The final consensus statement, therefore, represents the opinion of all participating centers based on the interpretation of the recent literature from 2010 to 2015 and includes the main findings of the so-called VICI-trial [3]. A consensus meeting, in which neonatologists, pediatric intensivists, gynecologists, prenatal physicians, pediatric surgeons, pediatric cardiologists and general pediatricians from 22 centers participated, was organized to discuss the most controversial recommendations.…”

Section: Methodsmentioning

confidence: 99%

Standardized Postnatal Management of Infants with Congenital Diaphragmatic Hernia in Europe: The CDH EURO Consortium Consensus - 2015 Update

et al. 2016

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In 2010, the congenital diaphragmatic hernia (CDH) EURO Consortium published a standardized neonatal treatment protocol. Five years later, the number of participating centers has been raised from 13 to 22. In this article the relevant literature is updated, and consensus has been reached between the members of the CDH EURO Consortium. Key updated recommendations are: (1) planned delivery after a gestational age of 39 weeks in a high-volume tertiary center; (2) neuromuscular blocking agents to be avoided during initial treatment in the delivery room; (3) adapt treatment to reach a preductal saturation of between 80 and 95% and postductal saturation >70%; (4) target PaCO₂ to be between 50 and 70 mm Hg; (5) conventional mechanical ventilation to be the optimal initial ventilation strategy, and (6) intravenous sildenafil to be considered in CDH patients with severe pulmonary hypertension. This article represents the current opinion of all consortium members in Europe for the optimal neonatal treatment of CDH.

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“…The SNAP takes only 2-4 minutes to calculate. The SNAP 2 score is considered independent of initial ventilation strategy [34].…”

Section: Herniamentioning

confidence: 99%

Congenital Diaphragmatic Hernia

2018

Imaging in Pediatrics

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Despite advances in neonatal and surgical care, the management of congenital diaphragmatic hernia (CDH) remains challenging with no definitive standard treatment guidelines. Several centers report mortality rates as low as 20%, but if extracorporeal membrane oxygenation (ECMO) support is required, the mortality rate rises to 50%. The disease severity is related to the degree of pulmonary hypoplasia and pulmonary hypertension that occurs with CDH. Both conditions decrease the infant's ability to ventilate and oxygenate adequately at delivery. These physiologic conditions that impair gas exchange are the important determinants of morbidity and mortality in CDH infants. Presently, delivery of infants with CDH is recommended close to term gestation. The focus of care includes gentle ventilation, hemodynamic monitoring, and treatment of pulmonary hypertension followed by surgery for the defect. Extracorporeal membrane oxygenation (ECMO) is considered after failure of conventional medical management for infants ≥ 34 weeks' gestation or with weight >2 kg and no associated major lethal anomalies. This chapter discusses long-term follow-up recommendations for survivors, which should involve a multidisciplinary approach, as there are many surgical and nonsurgical consequences to the disease process. Clinical strategies that address these multifaceted aspects of care, from prenatal to long-term follow-up, may further reduce the high mortality rate for these infants.

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Conventional Mechanical Ventilation Versus High-frequency Oscillatory Ventilation for Congenital Diaphragmatic Hernia

Cited by 229 publications

References 31 publications

Diagnosis and management of congenital diaphragmatic hernia: a clinical practice guideline

Diagnosis and management of congenital diaphragmatic hernia: a clinical practice guideline

Standardized Postnatal Management of Infants with Congenital Diaphragmatic Hernia in Europe: The CDH EURO Consortium Consensus - 2015 Update

Congenital Diaphragmatic Hernia

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