title: Congenital diaphragmatic hernia and protective ventilation strategies in pediatric surgery.
abstract: Infants affected with congenital diaphragmatic hernias (CDH) suffer from some degree of respiratory insufficiency arising from a combination of pulmonary hypoplasia and pulmonary hypertension. Respiratory care strategies to optimize blood gasses lead to significant barotrauma, increased morbidity, and overuse of extracorporeal membrane oxygenation (ECMO). Newer permissive hypercapnia/spontaneous ventilation protocols geared to accept moderate hypercapnia at lower peak airway pressures have led to improved outcomes. High-frequency oscillatory ventilation can be used in infants who continue to have persistent respiratory distress despite conventional ventilation. ECMO can be used successfully as a resuscitative strategy to minimize further barotrauma in carefully selected patients.
authors.affiliation: Division of Pediatric Surgery, Columbia University College of Physicians and Surgeons, 3959 Broadway, CHN 214, New York, NY 10032, USA.
authors.forename: Alejandro
authors.initials: A
authors.lastname: Garcia
authors.forename: Charles J H
authors.initials: CJ
authors.lastname: Stolar
mesh_terms: D001469:Barotrauma / Q000209:etiology / Q000517:prevention & control; D001997:Bronchopulmonary Dysplasia / Q000209:etiology / Q000517:prevention & control*; D015199:Extracorporeal Membrane Oxygenation; D006548:Hernia, Diaphragmatic / Q000150:complications / Q000601:surgery; D065630:Hernias, Diaphragmatic, Congenital; D006801:Humans; D006935:Hypercapnia / Q000209:etiology; D007223:Infant; D007231:Infant, Newborn; D012121:Respiration, Artificial / Q000009:adverse effects / Q000379:methods*; D012131:Respiratory Insufficiency / Q000209:etiology / Q000628:therapy*