Association of high ventilator pressures with the development of chronic pulmonary hypertension in congenital diaphragmatic hernia patients requiring ECMO.
OBJECTIVE
Congenital diaphragmatic hernia (CDH) patients requiring extracorporeal membrane oxygenation (ECMO) were examined to determine, if aspects of their complex ventilatory management were associated with the development of chronic pulmonary hypertension (cPH).


METHODS
CDH patients requiring ECMO from 1992 to 2007 were retrospectively reviewed. cPH was defined as pulmonary hypertension at 3 months of age. Demographic and clinical variables including peak ventilatory pressures (PVP) and mean airway pressures (MAP) were tabulated.


RESULTS
10/31 (32 %) patients developed cPH. Gestational age, birth weight, inborn status, CDH side and liver position were not different between cPH and non-cPH patients. Pre-ECMO, both groups required statistically similar ventilatory support, though there was a trend toward higher oxygenation index and higher PVP for cPH patients. While ECMO duration was similar between groups, cPH patients required significantly higher PVP (30.0 vs. 25.0 cmH(2)O, p = 0.01) and MAP (11.5 vs. 9.0 cmH(2)O, p = 0.02) for ECMO decannulation. Post-ECMO, maximum PVP (50.0 vs. 26.0 cmH(2)O, p < 0.001), MAP (18.1 vs. 12.0, p = 0.001), HFV requirement (90 vs. 10 %, p < 0.001), and ventilator time (35.7 vs. 20 days, p < 0.001) increased significantly for cPH patients.


CONCLUSIONS
Not until after ECMO decannulation do we see clinical differences separating patients who ultimately develop cPH. Although the degree of pulmonary hypoplasia may ultimately dictate ECMO decannulation criteria, perhaps greater physiologic optimization before decannulation could decrease the incidence of cPH.
Department of Surgery, University of Pennsylvania Health System, Philadelphia, PA, USA.
Jashodeep
J
Datta
Sharon E
SE
Phillips
Edmund Y
EY
Yang
D001724:Birth Weight; D006328:Cardiac Catheterization; D002908:Chronic Disease; D045422:Continuous Positive Airway Pressure / Q000009:adverse effects / Q000295:instrumentation*; D015199:Extracorporeal Membrane Oxygenation / Q000009:adverse effects / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D005865:Gestational Age; D006548:Hernia, Diaphragmatic / Q000150:complications / Q000628:therapy; D065630:Hernias, Diaphragmatic, Congenital; D006801:Humans; D006976:Hypertension, Pulmonary / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D007231:Infant, Newborn; D008297:Male; D011312:Pressure; D011669:Pulmonary Wedge Pressure; D012189:Retrospective Studies; D012122:Ventilators, Mechanical / Q000009:adverse effects*