Our Summary

The researchers conducted a study to determine the best method of assisted breathing (ventilation) for newborns undergoing a specific type of surgery (thoracoscopic repair) to fix a birth defect (congenital diaphragmatic hernia). This defect is a hole in the diaphragm, the muscle that separates the chest from the abdomen, which can cause problems with lung development and function.

They compared two types of ventilation: high-frequency oscillatory ventilation (HFOV), which provides very rapid, small breaths, and conventional mechanical ventilation (CMV), which provides slower, larger breaths.

The study included 23 newborns who underwent this surgery at their hospital between 2007 and 2016. They were initially given HFOV, but switched to CMV if certain conditions were met.

The researchers found that before surgery, the newborns on HFOV had higher levels of carbon dioxide (CO2) in their blood and a lower pH, indicating more acidity. Both of these values worsened during the surgery for both groups, but the group on CMV had a greater worsening of these values compared to their levels before the surgery.

In conclusion, the researchers found that HFOV seems to be more effective at preventing the worsening of high CO2 levels and acidity during this surgery in newborns with this birth defect, although CMV can also be used.

FAQs

  1. What is the optimal ventilation mode during thoracoscopic repair of neonatal congenital diaphragmatic hernia?
  2. How do high-frequency oscillatory ventilation and conventional mechanical ventilation compare in preventing deterioration of hypercapnia and acidosis during thoracoscopic repair in neonatal CDH cases?
  3. Can conventional mechanical ventilation be used for neonatal CDH cases during thoracoscopic repair?

Doctor’s Tip

A helpful tip a doctor might tell a patient about congenital diaphragmatic hernia repair is to discuss with their healthcare provider the optimal ventilation mode during thoracoscopic repair. In some cases, high-frequency oscillatory ventilation (HFOV) may be more effective in preventing hypercapnia and acidosis compared to conventional mechanical ventilation (CMV). Patients should be aware of the potential benefits of HFOV and discuss with their medical team to determine the best ventilation mode for their individual case.

Suitable For

Patients with congenital diaphragmatic hernia (CDH) who undergo thoracoscopic repair (TR) are typically recommended for surgery. In this study, neonatal CDH cases were evaluated, and it was found that high-frequency oscillatory ventilation (HFOV) may be a better ventilation mode during TR compared to conventional mechanical ventilation (CMV) in terms of preventing deterioration of hypercapnia and acidosis. Patients with CDH who require surgical repair and ventilation support may benefit from HFOV during the procedure.

Timeline

  • Preoperatively, the patient may present with symptoms such as difficulty breathing, cyanosis, and gastrointestinal complications due to the hernia.
  • The patient undergoes thoracoscopic repair of the congenital diaphragmatic hernia.
  • During the procedure, the patient is initially ventilated with high-frequency oscillatory ventilation (HFOV).
  • If the HFOV settings are decreased to certain levels, the patient may be switched to conventional mechanical ventilation (CMV).
  • Arterial blood gases are monitored in the perioperative period to assess ventilation status.
  • Postoperatively, patients ventilated with HFOV show less deterioration of hypercapnia and acidosis compared to those ventilated with CMV.
  • Both groups experience an increase in PaCO2 and a decrease in pH intraoperatively, but the deterioration is less severe in the HFOV group.
  • Overall, HFOV may be a better ventilation mode during thoracoscopic repair of neonatal congenital diaphragmatic hernia, but CMV can also be used effectively.

What to Ask Your Doctor

  1. What ventilation mode will be used during the thoracoscopic repair of my congenital diaphragmatic hernia (CDH)?
  2. How will the decision be made to switch between high-frequency oscillatory ventilation (HFOV) and conventional mechanical ventilation (CMV)?
  3. What are the potential risks and benefits of using HFOV versus CMV for ventilation during the procedure?
  4. How will my arterial blood gases be monitored during the perioperative period, and what results should I expect?
  5. How does the use of HFOV versus CMV affect postoperative outcomes and recovery for neonatal CDH cases?
  6. Are there any specific factors about my individual case that may influence the choice of ventilation mode during the procedure?
  7. What other factors should I consider when making decisions about the ventilation mode for my CDH repair surgery?

Reference

Authors: Okazaki T, Okawada M, Ishii J, Koga H, Miyano G, Doi T, Ogasawara Y, Lane GJ, Yamataka A. Journal: Pediatr Surg Int. 2017 Oct;33(10):1097-1101. doi: 10.1007/s00383-017-4143-y. Epub 2017 Aug 12. PMID: 28803335