High-frequency oscillatory ventilation versus conventional mechanical ventilation in congenital diaphragmatic hernia.
OBJECTIVE
Newborns affected by congenital diaphragmatic hernia (CDH) are high-risk patients: today the mortality is still elevated and is essentially due to severe pulmonary hypoplasia, pulmonary hypertension and the absence of surfactant. High-Frequency Oscillatory Ventilation (HFOV) seems to be a good pre- and postoperative technique in cases of CDH.


METHODS
We report our experience in the treatment of CDH; since 1987 we have followed 44 patients. We divided them into two different groups in accordance with the ventilation technique used: Group I (1987-1994): 25 patients treated with conventional mechanical ventilation (CMV); Group II (1994-1997): 19 patients treated with HFOV used since the first day of life until clinical stabilisation and also prolonged during surgery and in the postoperative period.


RESULTS
37 patients (84%) underwent surgery with closure of the diaphragmatic defect. We had a very good improvement in survival, rising from 67% (CMV) to 94% (HFOV) of the patients operated on, reaching an overall survival of 56% vs 79%.


CONCLUSIONS
The use of HFOV for the treatment of CDH has proved to be a valuable technique for pre-operative stabilisation and for intra- and postoperative respiratory treatment, above all for newborns with CDH.
Cacciari
A
A
Department of Paediatric Surgery, University of Bologna, Italy.
Ruggeri
G
G
Mordenti
M
M
Ceccarelli
P L
PL
Baccarini
E
E
Pigna
A
A
Gentili
A
A
D005260:Female; D006548:Hernia, Diaphragmatic / Q000601:surgery / Q000628:therapy*; D065630:Hernias, Diaphragmatic, Congenital; D006612:High-Frequency Ventilation; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D012121:Respiration, Artificial; D012189:Retrospective Studies