title: High-frequency oscillatory ventilation versus conventional mechanical ventilation in congenital diaphragmatic hernia.
abstract: 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.
authors.affiliation: Department of Paediatric Surgery, University of Bologna, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Cacciari
authors.forename: G
authors.initials: G
authors.lastname: Ruggeri
authors.forename: M
authors.initials: M
authors.lastname: Mordenti
authors.forename: P L
authors.initials: PL
authors.lastname: Ceccarelli
authors.forename: E
authors.initials: E
authors.lastname: Baccarini
authors.forename: A
authors.initials: A
authors.lastname: Pigna
authors.forename: A
authors.initials: A
authors.lastname: Gentili
mesh_terms: 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