title: A definition of gentle ventilation in congenital diaphragmatic hernia: a survey of neonatologists and pediatric surgeons.
abstract: Ventilation practices have changed significantly since the initial reports in the mid 1980 of successful use of permissive hypercapnia and spontaneous ventilation [often called gentle ventilation (GV)] in infants with congenital diaphragmatic hernia (CDH). However, there has been little standardization of these practices or of the physiologic limits that define GV. We sought to ascertain among Diaphragmatic Hernia Research and Exploration; Advancing Molecular Science (DHREAMS) centers' GV practices in the neonatal management of CDH. Pediatric surgeons and neonatologists from DHREAMS centers completed an online survey on GV practices in infants with CDH. The survey gathered data on how individuals defined GV including ventilator settings, blood gas parameters and other factors of respiratory management. A total of 87 respondents, from 12 DHREAMS centers completed the survey for an individual response rate of 53% and a 92% center response rate. Approximately 99% of the respondents defined GV as accepting higher carbon dioxide (PCO2) and 60% of the respondents also defined GV as accepting a lower pH. There was less consensus about the use of sedation and neuromuscular blocking agents in GV, both within and across the centers. Acceptable pH and PCO2 levels are broader than the goal ranges. Despite a lack of formal standardization, the results suggest that GV practice is consistently defined as the use of permissive hypercapnia with mild respiratory acidosis and less consistently with the use of sedation and neuromuscular blocking agents. GV is the reported practice of surveyed neonatologists and pediatric surgeons in the respiratory management of infants with CDH.
authors.affiliation: .
authors.forename: Christiana
authors.initials: C
authors.lastname: Farkouh-Karoleski
authors.affiliation: .
authors.forename: Tasnim
authors.initials: T
authors.lastname: Najaf
authors.affiliation: .
authors.forename: Julia
authors.initials: J
authors.lastname: Wynn
authors.affiliation: .
authors.forename: Gudrun
authors.initials: G
authors.lastname: Aspelund
authors.affiliation: .
authors.forename: Wendy K
authors.initials: WK
authors.lastname: Chung
authors.affiliation: .
authors.forename: Charles J
authors.initials: CJ
authors.lastname: Stolar
authors.affiliation: .
authors.forename: George B
authors.initials: GB
authors.lastname: Mychaliska
authors.affiliation: .
authors.forename: Brad W
authors.initials: BW
authors.lastname: Warner
authors.affiliation: .
authors.forename: Amy J
authors.initials: AJ
authors.lastname: Wagner
authors.affiliation: .
authors.forename: Robert A
authors.initials: RA
authors.lastname: Cusick
authors.affiliation: , and.
authors.forename: Foong-Yen
authors.initials: FY
authors.lastname: Lim
authors.affiliation: .
authors.forename: David T
authors.initials: DT
authors.lastname: Schindel
authors.affiliation: .
authors.forename: Douglas
authors.initials: D
authors.lastname: Potoka
authors.affiliation: .
authors.forename: Kenneth
authors.initials: K
authors.lastname: Azarow
authors.affiliation: .
authors.forename: C Michael
authors.initials: CM
authors.lastname: Cotten
authors.affiliation: .
authors.forename: Anthony
authors.initials: A
authors.lastname: Hesketh
authors.affiliation: .
authors.forename: Samuel
authors.initials: S
authors.lastname: Soffer
authors.affiliation: , CO, USA and the.
authors.forename: Timothy
authors.initials: T
authors.lastname: Crombleholme
authors.affiliation: .
authors.forename: Howard
authors.initials: H
authors.lastname: Needelman
mesh_terms: D065630:Hernias, Diaphragmatic, Congenital / Q000628:therapy*; D006801:Humans; D007231:Infant, Newborn; D000072156:Neonatologists / Q000706:statistics & numerical data; D012121:Respiration, Artificial / Q000592:standards* / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires
keywords: Clinician survey; congenital diaphragmatic hernia; ventilation