Annual Scientific Session of the American Surgical Association. San Diego, CA, USA, 1999/04.
Objective To evaluate the impact of a nonstandard ventilation strategy on survival in congenital diaphragmatic hernia (CDH).
Background Despite recent advances, including nitric oxide, CDH remains an unsolved problem with a mortality rate of 35% to 50%. Hyperventilation and alkalization remain common therapies.
Methods In 1992, the authors prospectively abandoned hyperventilation and alkalization.
Patients are lightly sedated and ventilated with the lowest pressure providing adequate chest movement, and the rate is set to patient comfort.
Nitric oxide and extracorporeal membrane oxygenation (ECMO) are reserved for life-threatening instability.
Surgical repair is delayed 1 to 5 days.
Sixty consecutive patients are compared with 29 previous patients treated with hyperventilation and alkalization, 13 before and 16 after the availability of ECMO.
Results Overall, 47 of 60 patients (78%) in study era 3 survived compared with 2 of 13 (15%) in the hyperventilation era and 7 of 16 (44%) in the hyperventilation/ECMO era (p<0.0001).
The disease severity and the incidence of associated anomalies did not differ between groups.
To compare management strategies, patients who had treatment withheld because of lethal associated conditions were then removed from analysis.
Peak inspiratory pressure and arterial pH were lower (p<0.0001) and Paco2 was higher (p<0.05) in era 3 than in the previous eras.
The rate of pneumothorax (1.9%) decreased (p<0.0001). (...)
Mots-clés Pascal : Hernie, Diaphragme, Congénital, Ventilation, Etude cohorte, Cote nivellement, Stratégie, Traitement, Circuit extracorporel, Oxygénateur membrane, Evaluation, Nouveau né, Homme, Etats Unis, Amérique du Nord, Amérique, Muscle respiratoire, Appareil respiratoire pathologie, Malformation, Technique, Traitement instrumental
Mots-clés Pascal anglais : Hernia, Diaphragm, Congenital, Ventilation, Cohort study, Bench mark, Strategy, Treatment, Extracorporeal circuit, Membrane oxygenator, Evaluation, Newborn, Human, United States, North America, America, Respiratory muscle, Respiratory disease, Malformation, Technique, Instrumentation therapy
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Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 99-0516331
Code Inist : 002B26D. Création : 18/05/2000.