Congenital diaphragmatic hernia : A tale of two cities : The Boston experience.
Annual International Congress of the British Association of Paediatric Surgeons. St Helier, Jersey (GBR), 1996/07/16.
Infants with congenital diaphragmatic hernia (CDH) show a wide range of anatomic and physiological abnormalities, making it difficult to compare the efficacy of management protocols between institutions.
The purpose of this study was twofold : (1) to analyze the results of treatment of CDH in a large tertiary care pediatric center using conventional mechanical ventilation (CMV) with extracorporeal membrane oxygenation (ECMO) as rescue therapy, and (2) to compare these results with those of a parallel study by a similar large urban center that used high-frequency oscillating ventilation (HFOV) as rescue therapy without ECMO.
All patients who had CDH diagnosed within the first 12 hours of life and were referred for treatment before repair (between 1981 and 1994) were included in the analysis (n=196).
CMV was used initially in all patients, with conversion to ECMO for refractory hypoxemia or hypercapnea.
Between 1981 and 1984, ECMO was not available.
Between 1984 and 1987, ECMO was offered postoperatively.
Between 1987 and 1991, ECMO was offered preoperatively.
In all three groups, aggressive hyperventilation and alkalosis was the norm.
Since 1991, permissive hypercapnia has been used.
HFOV was used in three patients as stand-alone therapy with one survivor.
Twenty patients died without repair :
Ten had other lethal anomalies, eight died before ECMO could be instituted, and two died of ECMO-related complications.
Overall, 104 patients (53%) survived and 92 (47%) died. (...)
Mots-clés Pascal : Hernie, Diaphragme, Congénital, Circuit extracorporel, Oxygénateur membrane, Etude comparative, Ventilation, Oscillateur haute fréquence, Pédiatrie, Efficacité traitement, Evaluation, Etats Unis, Amérique du Nord, Amérique, Muscle respiratoire, Appareil respiratoire pathologie, Malformation, Appareil circulatoire pathologie
Mots-clés Pascal anglais : Hernia, Diaphragm, Congenital, Extracorporeal circuit, Membrane oxygenator, Comparative study, Ventilation, High frequency oscillator, Pediatrics, Treatment efficiency, Evaluation, United States, North America, America, Respiratory muscle, Respiratory disease, Malformation, Cardiovascular disease
Notice produite par :
Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 97-0360491
Code Inist : 002B11D. Création : 12/09/1997.