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Tidal volume in infants with congenital diaphragmatic hernia supported with conventional mechanical ventilation

Saumya Sharma1, Kabir M Abubakar1, Martin Keszler2

  • 1Division of Neonatology, Department of Pediatrics, Georgetown University Hospital, Washington, District of Columbia.

American Journal of Perinatology
|January 22, 2015
PubMed

Insights

Infants with congenital diaphragmatic hernia (CDH) need similar tidal volumes (VT) for CO2 removal as healthy infants. This study provides crucial reference values for VT selection in CDH patients.

Area of Science:

  • Neonatal Medicine
  • Pediatric Pulmonology
  • Critical Care

Background:

  • Congenital diaphragmatic hernia (CDH) is a condition with significant respiratory implications.
  • Assessing appropriate ventilatory support, specifically tidal volume (VT), is critical for managing eucapnia in infants with CDH.

Purpose of the Study:

  • To test the hypothesis that tidal volume (VT) for maintaining eucapnia in infants with congenital diaphragmatic hernia (CDH) is not reduced proportionally to their lung mass.
  • To establish reference values for VT in infants with CDH.

Main Methods:

  • Retrospective review of infants with CDH managed with conventional ventilation (1997-2009).
  • Collected data included demographics, ventilator settings, VT, respiratory rate (RR), and blood gas values.
  • Minute ventilation (MV) was calculated (RR × VT). VT and MV per kilogram were analyzed for patients with Paco2 between 35-60 mm Hg.
  • A control group of infants without CDH or pulmonary hypoplasia was used for comparison.

Main Results:

  • Infants with CDH and control infants had similar birth weights and gestational ages (p=0.02).
  • Infants with CDH required similar VT and MV to maintain eucapnia (Paco2) compared to controls.
  • These findings suggest VT is not reduced to the same degree as lung mass in CDH.

Conclusions:

  • Infants with CDH demonstrate a similar need for tidal volume (VT) for CO2 clearance compared to infants of similar size without pulmonary hypoplasia.
  • This study provides the first reference values to guide the selection of VT in infants diagnosed with CDH.
Abstract

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