title: Venovenous ECMO for Congenital Diaphragmatic Hernia: Role of Ductal Patency and Lung Recruitment.
abstract: We report a case of antenatally diagnosed left-sided congenital diaphragmatic hernia, managed on venovenous extracorporeal membrane oxygenation with an hemodynamic and ventilation strategy aimed at preventing left and right ventricular dysfunction. Keeping the ductus arteriosus open with prostaglandin infusion and optimizing lung recruitment were effective in achieving hemodynamic stabilization and an ideal systemic oxygen delivery. The patient was discharged from the hospital and had normal development at 1 year of age. The combination of ductal patency and lung recruitment has not been previously reported as a strategy to stabilize congenital diaphragmatic hernia patients undergoing venovenous extracorporeal membrane oxygenation. We believe that this approach may deserve further evaluation in prospective studies.
authors.affiliation: Neonatal and Pediatric ICU, Department of Critical Care and Perinatal Medicine, and andreamoscatelli@me.com.
authors.forename: Andrea
authors.initials: A
authors.lastname: Moscatelli
authors.affiliation: Neonatal and Pediatric ICU, Department of Critical Care and Perinatal Medicine, and.
authors.forename: Stefano
authors.initials: S
authors.lastname: Pezzato
authors.affiliation: Division of Neonatology, Vittore Buzzi Children's Hospital ICP, Milano, Italy.
authors.forename: Gianluca
authors.initials: G
authors.lastname: Lista
authors.affiliation: Neonatal and Pediatric ICU, Department of Critical Care and Perinatal Medicine, and.
authors.forename: Lara
authors.initials: L
authors.lastname: Petrucci
authors.affiliation: Neonatal and Pediatric ICU, Department of Critical Care and Perinatal Medicine, and.
authors.forename: Silvia
authors.initials: S
authors.lastname: Buratti
authors.affiliation: Division of Infectious Diseases, Department of Pediatrics, Istituto Giannina Gaslini, Genova, Italy; and.
authors.forename: Elio
authors.initials: E
authors.lastname: Castagnola
authors.affiliation: Neonatal and Pediatric ICU, Department of Critical Care and Perinatal Medicine, and.
authors.forename: Pietro
authors.initials: P
authors.lastname: Tuo
mesh_terms: D000015:Abnormalities, Multiple / Q000000981:diagnostic imaging / Q000628:therapy; D004374:Ductus Arteriosus, Patent / Q000000981:diagnostic imaging* / Q000503:physiopathology; D015199:Extracorporeal Membrane Oxygenation / Q000379:methods*; D005500:Follow-Up Studies; D006439:Hemodynamics / Q000502:physiology; D065630:Hernias, Diaphragmatic, Congenital / Q000000981:diagnostic imaging* / Q000628:therapy*; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D008168:Lung / Q000002:abnormalities / Q000000981:diagnostic imaging; D008297:Male; D010101:Oxygen Consumption / Q000502:physiology; D011296:Prenatal Diagnosis / Q000379:methods; D012129:Respiratory Function Tests; D018570:Risk Assessment; D016896:Treatment Outcome