Effects of ventilation modalities on near-infrared spectroscopy in surgically corrected CDH infants.
BACKGROUND
Near-infrared spectroscopy (NIRS) is a noninvasive technique for monitoring tissue oxygenation and perfusion. The aim of this study was to evaluate cerebral and splanchnic NIRS changes in CDH operated infants enrolled into the VICI trial and therefore randomized for ventilatory modalities.


METHODS
CDH newborns enrolled into the VICI trial (Netherlands Trial Register, NTR 1310) were randomized at birth for high-frequency oscillatory ventilation (HFOV) or conventional mechanical ventilation (CMV) according to the trial. Cerebral oxygenation (rSO2C) and splanchnic oxygenation (rSO2S) were obtained by NIRS (INVOS 5100; Somanetics, Troy, MI) before and after surgery. Variations in rSO2C and rSO2S were evaluated. Mann-Whitney test and one-way ANOVA were used as appropriate. p<0.05 was considered significant.


RESULTS
Thirteen VICI trial patients underwent surgical repair between March 2011 and December 2012, and were enrolled in the study. Seven patients were assigned to HFOV and six to CMV group respectively. During surgery, a significant reduction in rSO2C (p=0.0001) and rSO2S (p=0.005) were observed. HFOV patients experienced prolonged reduction in rSO2C value (p=0.003) while rSO2S did not vary between HFOV and CMV (p=0.94).


CONCLUSIONS
Surgical CDH repair was associated with decrease of cerebral and splanchnic oxygenation, regardless of ventilation. Patients ventilated by HFOV need a longer time interval to recovery normal rSO2C values, than those ventilated by CMV. This may be owing to a different impact of HFOV on patients' hemodynamic status with a higher impairment on total venous return and its negative consequences on cardiac output.
Department of Medical and Surgical Neonatology, Bambino Gesù Children's Hospital, Rome, Italy. Electronic address: andrea.conforti@opbg.net.
Andrea
A
Conforti
Department of Medical and Surgical Neonatology, Bambino Gesù Children's Hospital, Rome, Italy.
Paola
P
Giliberti
Department of Medical and Surgical Neonatology, Bambino Gesù Children's Hospital, Rome, Italy.
Francesca
F
Landolfo
Department of Medical and Surgical Neonatology, Bambino Gesù Children's Hospital, Rome, Italy.
Laura
L
Valfrè
Department of Medical and Surgical Neonatology, Bambino Gesù Children's Hospital, Rome, Italy.
Claudia
C
Columbo
Department of Medical and Surgical Neonatology, Bambino Gesù Children's Hospital, Rome, Italy.
Vito
V
Mondi
Department of Medical and Surgical Neonatology, Bambino Gesù Children's Hospital, Rome, Italy.
Irma
I
Capolupo
Department of Medical and Surgical Neonatology, Bambino Gesù Children's Hospital, Rome, Italy.
Andrea
A
Dotta
Department of Medical and Surgical Neonatology, Bambino Gesù Children's Hospital, Rome, Italy.
Pietro
P
Bagolan
D001921:Brain / Q000098:blood supply*; D003131:Combined Modality Therapy; D005260:Female; D065630:Hernias, Diaphragmatic, Congenital / Q000503:physiopathology / Q000601:surgery* / Q000628:therapy; D059685:Herniorrhaphy; D006612:High-Frequency Ventilation / Q000379:methods; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D011446:Prospective Studies; D016032:Randomized Controlled Trials as Topic; D012121:Respiration, Artificial / Q000379:methods*; D019265:Spectroscopy, Near-Infrared; D013152:Splanchnic Circulation; D016896:Treatment Outcome
CMV; Congenital diaphragmatic hernia; HFOV; NIRS; conventional mechanical ventilation; high-frequency oscillatory ventilation