Congenital diaphragmatic hernia : A tale of two cities : The Toronto experience.
Annual International Congress of the British Association of Paediatric Surgeons. St Helier, Jersey (GBR), 1996/07/16.
The optimal therapy for congenital diaphragmatic hernia (CDH) is evolving.
This study analyzes the results of treatment of CDH in a large tertiary care pediatric center using conventional and high-frequency oscillatory ventilation (HFOV) without extracorporeal membrane oxygenation (ECMO) contrasting these with a parallel study from a similar large urban center using conventional ventilation with ECMO.
Between 1981 and 1994,223 consecutive neonates who had CDH diagnosed in the first 12 hours of life were referred for treatment before repair.
Conventional ventilation was used with conversion to HFOV for refractory hypoxemia or hypercapnia, and a predicted near 100% mortality rate.
ECMO was used in only three patients, all of whom died.
A retrospective database was collected
Thirty-one clinical variables were tested for their association with the outcome.
Common ventilatory and oxygenation indices were tested for their prognostic capability.
Apgar scores, birth weight, right-sided defects, pneumothorax, total ventilatory time, and the use of high frequency oscillatory ventilation were the only variables associated with outcome.
A modified ventilatory index and postductal A-aDo2 were strong prognostic indicators.
From 1981 to 1984 surgery was performed on an emergency basis.
Since 1985 surgery was deferred until stabilization had been achieved. (...)
Mots-clés Pascal : Hernie, Diaphragme, Congénital, Protocole expérimental, Oscillateur haute fréquence, Ventilation, Etude comparative, Facteur prédictif, Pédiatrie, Circuit extracorporel, Oxygénateur membrane, Evaluation, Hypoplasie, Artère pulmonaire, Homme, Canada, Amérique du Nord, Amérique, Muscle respiratoire, Appareil respiratoire pathologie, Malformation, Traitement instrumental, Appareil circulatoire pathologie, Vaisseau sanguin pathologie, Artère pathologie, Maladie congénitale
Mots-clés Pascal anglais : Hernia, Diaphragm, Congenital, Experimental protocol, High frequency oscillator, Ventilation, Comparative study, Predictive factor, Pediatrics, Extracorporeal circuit, Membrane oxygenator, Evaluation, Hypoplasia, Pulmonary artery, Human, Canada, North America, America, Respiratory muscle, Respiratory disease, Malformation, Instrumentation therapy, Cardiovascular disease, Vascular disease, Arterial disease, Congenital disease
Notice produite par :
Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 97-0360490
Code Inist : 002B11D. Création : 12/09/1997.