Right-sided congenital diaphragmatic hernia: high utilization of extracorporeal membrane oxygenation and high survival

Bryner, Benjamin S.; Kim, Anne C.; Khouri, Joseph S.; Drongowski, Robert A.; Bruch, Steven W.; Hirschl, Ronald B.; Mychaliska, George B.

doi:10.1016/j.jpedsurg.2009.01.037

Cited by 29 publications

(22 citation statements)

References 27 publications

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“…This finding is supported by previous studies in which patients with R-CDH have been found to have a high ECMO utilization rate [6,10]. It is important to note that it has also been found that when patients were matched by fetal lung volumes, the utilization of ECMO was equivalent [12] thus corroborating other studies in which fetal lung volumes have been found to be a predictor of pulmonary morbidity and ECMO use [21], and not hemodynamic issues related to the right sided liver herniation.…”

Section: A C C E P T E D Accepted Manuscriptsupporting

confidence: 86%

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Revisiting outcomes of right congenital diaphragmatic hernia

Akinkuotu

Cruz

Cass

et al. 2015

Journal of Surgical Research

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Section: A C C E P T E D Accepted Manuscriptsupporting

confidence: 86%

“…In some studies, R-CDH is associated with an increased use of ECMO in the neonatal period and risk of chronic lung disease [10,11]. On the other hand, a recent study examining CDH patients with equal prenatal lung volumes found that there was no difference in pulmonary morbidity between R and L-CDH [12].…”

Section: Introductionmentioning

confidence: 99%

Revisiting outcomes of right congenital diaphragmatic hernia

Akinkuotu

Cruz

Cass

et al. 2015

Journal of Surgical Research

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“…We observed a significantly higher rate of prenatal diagnosis of LCDH compared to right CDH (81.9% vs. 63.1%) in this study. However, this rate of RCDH prenatal diagnosis is also higher than what has been published previously [5,14,22,26]. The reason for this is unclear.…”

Section: Discussionmentioning

confidence: 61%

Clinical characteristics and outcomes of patients with right congenital diaphragmatic hernia: A population-based study

Beaumier

Beres

Puligandla

et al. 2015

Journal of Pediatric Surgery

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“…The factors affecting LCDH survival, like associated cardiac anomalies, a need for ECMO, time to repair, cannot be extrapolated to R CDH survival [2,3]. R CDH has high ECMO utilization and it experiences greater relative benefit from ECMO [4]. ECMO facilities were not available at our hospital.…”

Section: Discussionmentioning

confidence: 99%

Anaesthetic Management of a Neonate with Right Sided Congenital Diaphragmatic Hernia

Kapart¹

2013

JCDR

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A 5-day-old female baby weighing 2 kg was brought to the Emergency Room (ER) of our hospital by the mother, with complaints that the baby was crying excessively and that she was not feeding since past 2 days. The baby was delivered at home by a trained birth attendant and she cried immediately after her birth. The mother had not undergone any antenatal checkups during her pregnancy.In the ER, the baby was in severe respiratory distress, with a Respiratory Rate (RR) of 80/min and oxygen saturation (SpO 2 ) of 70% on room air. Systemic examination showed decreased air entry on right side, apex beat shifted to left and a scaphoid abdomen. ABG showed pH: 7.28, partial pressure of oxygen(PaO 2 )-54 mm Hg and partial pressure of carbon dioxide(PaCO 2 ) -55mm Hg. The baby was immediately intubated with a size 3.0 endotracheal tube. A nasogastric tube was placed. The chest X-ray showed subnormal lung expansion on right, herniated bowels, with air and fluid in right hemi-thorax . Chest and other mediastinal structures were shifted to left and there was no liver herniation. A diagnosis of RCDH was made and it was confirmed with X-ray Gastrografin. The baby was shifted to neonatal intensive care unit (NICU) for ventilator support. The initial ventilator settings were pressure control (PCV) mode of ventilation, inspiratory pressure(P insp ) -15 cm H 2 O, peak end expiratory pressure (PEEP) -4 cmH 2 O and inspired fraction of oxygen(FiO 2 ) -1.0. ECHO showed a patent ductus arteriosus with a right to left shunt and pulmonary artery pressure of 45mmHg. Circulatory support was provided with inj Dopamine, along with maintanance fluid. Surgery was planned after pre-operative stabilization of the baby.After 2 days of ventilation, pre-ductal and post-ductal arterial blood gas (ABG) sampling was done. The PaO 2 was 68mmHg (preductal) and 60mmHg (post-ductal) and SpO 2 was 92%(pre-ductal) and 88%(post-ductal) at FiO 2 of 0.4. The baby maintained normal haemodynamic parameters with no circulatory support. As the preoperative stabilization goals were achieved, the case was accepted for surgery. A written and informed consent for surgery was obtained from the parents and the case was shifted to operation theatre with ambu ventilation and oxygen (O 2 ) supplementation. The baby was ventilated with 100% O 2 , as the facility to provide air was not available in our anaesthesia machines.The stomach was decompressed by naso gastric tube suction and inj Fentanyl 10mcg and inj ondansetron 1mg were given. Monitors like those of Electro Cardio Gram (ECG), Non-Invasive Blood Pressure (NIBP), 2 pulse oximeters (pre-ductal and post-ductal) and temperature were connected. Baseline readings of HR-122/ min, BP -78/44mmhg, SpO 2 -92% and a temp of 37ºC were noted. A precordial stethoscope and a urinary catheter were placed. Anaesthesia was maintained with sevoflurane 2% and inj atracurium (bolus dose of 1mg and maintenance dose 0.01mg/kg).A right sub-costal incision was made, with the baby in supine position. Bowel loops in right hemithorax were ident...

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Right-sided congenital diaphragmatic hernia: high utilization of extracorporeal membrane oxygenation and high survival

Cited by 29 publications

References 27 publications

Revisiting outcomes of right congenital diaphragmatic hernia

Revisiting outcomes of right congenital diaphragmatic hernia

Clinical characteristics and outcomes of patients with right congenital diaphragmatic hernia: A population-based study

Anaesthetic Management of a Neonate with Right Sided Congenital Diaphragmatic Hernia

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