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  • 1
    Electronic Resource
    Electronic Resource
    Entry criteria for extracorporeal membrane oxygenation In neonates with congenital diaphragmatic hernia treated with high-frequency oscillatory ventilation (1996)
    Springer
    Pediatric surgery international 11 (1996), S. 532-535 
    Details
    ISSN: 1437-9813
    Keywords: Extracorporeal membrane oxygenation ; High-frequency oscillatory ventilation ; Congenital diaphragmatic hernia ; Oxygenation index ; Alveolararterial oxygen gradient
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Although respiratory management with high-frequency oscillatory ventilation (HFOV) has generally been used for neonates with congenital diaphragmatic hernia (CDH), entry criteria for extracorporeal membrane oxygenation (ECMO) based on data from patients who underwent HFOV have not yet been reported. To establish entry criteria for ECMO in such patients, we retrospectively studied 36 neonates with CDH treated by HFOV in our institutions between 1986 and 1994. From the admission records, preductal and postductal arterial blood gas data and HFOV ventilation conditions for 72 h after admission were extracted. Oxygenation index (01) and alveolar-arterial oxygen gradient (A-aD02) time interval combinations were calculated. Patients were divided into two groups: candidates for ECMO (n = 22) who underwent ECMO (n = 18) or died without ECMO (n = 4); and non-candidates (n = 14), who survived without ECMO. Blood gas data in patients placed on ECMO were comparable to those in patients who died without ECMO: mean pre- and postductal OI for 4 h 〉 30, postductal A-aD02 ≥620 mmHg for 4 h, postductal A-aD02 ≥580 mmHg for 8 h, and postductal A-aD02 ?550 mmHg for 12 h showed better sensitivity with a specificity of more than 90% compared to entry criteria that had previously been used in our institutions: a postductal OI 〉40 for 4 h and postductal A-aDO2 ≥610 mmHg for 8 h. In addition, a combination of preand postductal OI 〉30 for 4 h indicated a sensitivity of 95.5% and a specificity of 92.9%.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00626059
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  • 2
    Electronic Resource
    Electronic Resource
    Prenatal diagnosis of congenital diaphragmatic hernia and pulmonary hypoplasia and therapeutic strategy (1996)
    Springer
    Pediatric surgery international 11 (1996), S. 512-517 
    Details
    ISSN: 1437-9813
    Keywords: Prenatal diagnosis ; Congenital diaphragmatic hernia ; Pulmonary hypoplasia ; High-frequency oscillatory ventilation ; Extracorporeal membrane oxygenation
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The outcome of fetuses with congenital diaphragmatic hernia (CDH) has been reported to be fatal when pulmonary hypoplasia (PH) is severe. As an indicator of PH, we attempted to measure the lung-thorax transverse area ratio (L/T) using ultrasonic echography. Immediate postnatal surgery was performed using high-frequency oscillatory ventilation (HFOV) and sometimes followed by extracorporeal membrane oxygenation (ECMO). Eighteen fetuses were treated and 14 survived. L/T correlated well with the best preductal arterial blood gas data before surgical reduction during manual ventilation and HFOV, while preductal PO2 and alveolar-arterial oxygen differences from patients managed with HFOV were better than those in patients with manual ventilation. Although L/T also correlated with the duration of O2 therapy and hospitalization in survivors without major anomalies, there was no significant difference between L/T in survivors and nonsurvivors. Because delayed institution of ECMO and complications related to ECMO management seemed to be a major cause of death in non-survivors, the unsalvageable L/T due to PH was estimated to be below 0.06 for HFOV and below 0.1 for conventional ventilation based on the correlation between L/T and preductal P02. These results suggest that L/T is a useful indicator of PH in patients with CDH and also that HFOV is advantageous in treating CDH with PH. The advantage of prenatal diagnosis in predicting unsalvageable L/Ts, should be considered in the therapeutic strategy.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00626055
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    Paper (German National Licenses)
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  • 3
    Electronic Resource
    Electronic Resource
    Prolonged preoperative stabilization using high-frequency oscillatory ventilation does not improve the outcome in neonates with congenital diaphragmatic hernia (1998)
    Springer
    Pediatric surgery international 13 (1998), S. 542-546 
    Details
    ISSN: 1437-9813
    Keywords: Key words Extracorporeal membrane oxygenation ; High-frequency oscillatory ventilation ; congenital diaphragmatic hernia ; Prenatal diagnosis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Although delayed repair with preoperative stabilization using high-frequency oscillatory ventilation (HFOV) has been advocated in neonates with congenital diaphragmatic hernia (CDH), improved survival has not been reported. We compared survival between neonates undergoing delayed repair after prolonged stabilization for more than 48 h using HFOV and those undergoing immediate repair following short stabilization using HFOV in subjects with high-risk CDH. Patient selection was made by two criteria: fetuses with the lung/thorax transverse area ratio (L/T) below 0.26 and neonates who presented with respiratory distress significant enough to require intubation within 6 h after delivery. Selection of the strategies differed by era and medical center. Stabilization failed in 11 of 18 patients with delayed repair and only 7 patients (38.9%) in this group survived, but 18 of 23 patients (78.3%) in the immediate-repair group survived (P 〈 0.05). Although lower values of Apgar scores, best postductal PO2 (BPtDPO2), gestational weeks, and L/T and more frequent patch repair were observed in the delayed than in the immediate repair group, significant differences in survival among the subpopulations were also observed in the prenatally diagnosed group, including the group with L/T 〈 0.15 and the group that required ECMO, the group with the best preductal PO2 (BPrDPO2) ≥ 100 torr, and the group with BPtDPO2 〈 100 torr. These results indicate that prolonged stabilization for more than 48 h using HFOV does not improve survival in patients with high-risk CDH.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s003830050398
    Library Location Call Number Volume/Issue/Year Availability
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    Paper (German National Licenses)
    Fulltext
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