title: Reduction in ventilator-induced lung injury improves outcome in congenital diaphragmatic hernia?
abstract: The purpose of this historical study was to compare the outcome for two treatment strategies, for neonates with congenital diaphragmatic hernia (CDH). The records of 65 infants born between 1991 and 2005 with CDH from a single tertiary care perinatal centre in the United Kingdom were retrospectively reviewed. Conventional mechanical ventilation (CMV) and systemic vasodilators were used from 1991 to 1995 (era 1). High frequency oscillatory ventilation (HFOV) and nitric oxide (NO) were used between 1996 and 2005 (era 2). Main outcome measures were survival and incidence of chronic lung disease. The results showed that the survival rate was 38% (8/21) in era 1 and 73% (32/44) in era 2, 95% CI for difference -59 to -10%. The incidence of chronic lung disease in survivors was 45% (5/11) in era 1 and 30% (9/30) in era 2, 95% CI for difference -18 to 49%. These data show significantly improved survival with elective use of HFOV and NO compared to CMV and systemic vasodilators. The survival results for CDH at St George's Hospital are comparable to those published from other institutions. The results may reflect a reduction in ventilator-induced lung injury with HFOV compared to CMV.
authors.affiliation: Department of Neonatology, St Mary's Hospital, 1st Floor, Bays Building, Praed Street, London, W2 1NY, UK. geraldine.ng@imperial.nhs.uk
authors.forename: Geraldine Yin Taeng
authors.initials: GY
authors.lastname: Ng
authors.forename: Catherine
authors.initials: C
authors.lastname: Derry
authors.forename: Louise
authors.initials: L
authors.lastname: Marston
authors.forename: Moti
authors.initials: M
authors.lastname: Choudhury
authors.forename: Keith
authors.initials: K
authors.lastname: Holmes
authors.forename: Sandra Adamson
authors.initials: SA
authors.lastname: Calvert
mesh_terms: D001469:Barotrauma / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D005260:Female; D006548:Hernia, Diaphragmatic / Q000453:epidemiology / Q000628:therapy*; D065630:Hernias, Diaphragmatic, Congenital; D006612:High-Frequency Ventilation / Q000009:adverse effects*; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D055370:Lung Injury; D008297:Male; D009569:Nitric Oxide / Q000627:therapeutic use; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D015996:Survival Rate; D016896:Treatment Outcome; D014665:Vasodilator Agents / Q000627:therapeutic use
chemical_list: D014665:Vasodilator Agents; D009569:Nitric Oxide