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Early perfluorodecalin lung distension in infants with congenital diaphragmatic hernia
G M Walker1, K F Kasem, S J O'Toole
1Department of Surgical Paediatrics, Royal Hospital for Sick Children, Yorkhill NHS Trust, Glasgow, Scotland.
Insights
Perfluorodecalin lung distension in infants with severe congenital diaphragmatic hernia (CDH) on ECMO support significantly increased lung size. This approach shows promising outcomes for neonates with CDH, potentially promoting lung growth.
Area of Science:
- Neonatal Medicine
- Pediatric Surgery
- Pulmonary Medicine
Background:
- Pulmonary hypoplasia is a major cause of mortality in infants with severe congenital diaphragmatic hernia (CDH).
- Accelerated postnatal lung growth has been observed in animal models using perfluorocarbon lung distension.
- This study investigates perfluorodecalin lung distension in neonates with severe CDH requiring extracorporeal membrane oxygenation (ECMO) support.
Purpose of the Study:
- To measure the effects of perfluorodecalin lung distension on lung volume in neonates with severe CDH on ECMO.
- To assess the radiographic changes and clinical outcomes associated with this intervention.
Main Methods:
- Six neonates with severe CDH requiring ECMO were treated with perfluorodecalin lung instillation and continuous positive airway pressure for a mean of 7.7 days.
- Perfluorodecalin was exchanged four times daily.
- Lung volume was estimated from radiographic projections using the ECMO cannula as a reference.
Main Results:
- Perfluorodecalin instillation began shortly after ECMO initiation (mean 13.5 hours).
- A significant increase in lung volume was observed (affected lung: 272% increase; contralateral lung: 51% increase; P <.02 for both).
- All six patients survived and underwent CDH repair on ECMO.
Conclusions:
- Early perfluorodecalin lung distension in severe CDH neonates on ECMO leads to significant radiographic lung enlargement.
- Clinical outcomes are encouraging, with all patients surviving.
- Potential mechanisms include alveolar recruitment, dilatation, and accelerated postnatal lung growth.
Background/Purpose:
Pulmonary hypoplasia contributes to mortality in infants with severe congenital diaphragmatic hernia (CDH). Accelerated postnatal lung growth with perfluorocarbon lung distension has been demonstrated in animals. The authors present a study measuring perfluorodecalin distension in neonates with severe CDH on extracorporeal membrane oxygenation (ECMO) support.
Methods:
Six consecutive neonates with CDH requiring ECMO support were recruited. The lungs were filled with perfluorodecalin, and continuous positive airway pressure was applied for 6 to 10 days (mean, 7.7 days +/- 0.7). The perfluorodecalin was exchanged 4 times a day. Radiographic lung projections were measured, and from 2-dimensional measurements an estimated lung volume was calculated using the ECMO cannula as reference.
Results:
Perfluorodecalin instillation started soon after starting ECMO support (mean, 13.5 +/- 5.3 hours). The volume required to fill the lungs increased significantly (P <.02). The radiographic dimension of the affected lung increased significantly (mean percentage increase, 272%; P <.02). The contralateral lung dimension also increased (mean percentage increase 51%; P <.02). CDH repair was undertaken on ECMO in all cases. All patients survived (follow-up, 3 to 42 months).
Conclusions:
This protocol of early perfluorodecalin lung distension in infants with severe CDH on ECMO support resulted in significant radiographic lung enlargement. Clinical outcomes are encouraging. Possible mechanisms include alveolar recruitment, alveolar dilatation, and accelerated postnatal lung growth.