title: Respiratory distress associated with inadequate mechanical ventilator flow response in a neonate with congenital diaphragmatic hernia.
abstract: The incidence of congenital diaphragmatic hernia has been reported as 0.17-0.66 per 1,000 births. Despite advances in neonatal intensive care, congenital diaphragmatic hernia is associated with high mortality and morbidity. We report a neonate who was born with a left congenital diaphragmatic hernia and underwent surgical repair. The lack of ventilator flow response and flow cycling was identified via interpretation of the ventilator graphic and clinical assessment. Presumably, the ventilator failed to respond to the patient's peak inspiratory flow demand, despite the clinician's setting the highest peak flow available. A time-cycled pressure-limited mode with adjustable peak flow rate was the only option that met the infant's flow requirement, and alleviated the respiratory distress. This clinical finding follows bench research that raises the concern that so called "cradle-to-grave" ventilators may not optimally support all neonates.
authors.affiliation: Respiratory Care Department, Children's Hospital Boston, Boston, Massachusetts 02115, USA. brian.walsh@childrens.harvard.edu
authors.forename: Brian K
authors.initials: BK
authors.lastname: Walsh
authors.forename: Nancy
authors.initials: N
authors.lastname: Craig
authors.forename: Peter
authors.initials: P
authors.lastname: Betit
authors.forename: John E
authors.initials: JE
authors.lastname: Thompson
authors.forename: John H
authors.initials: JH
authors.lastname: Arnold
mesh_terms: D019544:Equipment Failure Analysis; D006548:Hernia, Diaphragmatic / Q000150:complications* / Q000601:surgery; D065630:Hernias, Diaphragmatic, Congenital; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D012121:Respiration, Artificial / Q000009:adverse effects*; D012127:Respiratory Distress Syndrome, Newborn / Q000209:etiology / Q000628:therapy*