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Published on: December 22, 2023

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Work of breathing at different tidal volume targets in newborn infants with congenital diaphragmatic hernia

Rebecca Lee1, Katie A Hunt1, Emma E Williams1

  • 1Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK.

European Journal of Pediatrics
|March 19, 2022
PubMed

Insights

Volume targeted ventilation (VTV) of 4 ml/kg increases the work of breathing in infants with congenital diaphragmatic hernia (CDH). A VTV of 5 ml/kg is recommended to reduce work of breathing in post-surgical CDH patients.

Area of Science:

  • Neonatal Medicine
  • Pediatric Surgery
  • Respiratory Physiology

Background:

  • Congenital diaphragmatic hernia (CDH) is associated with pulmonary hypoplasia, increasing mortality and morbidity.
  • Mechanical ventilation can cause lung injury in neonates with CDH.
  • Volume targeted ventilation (VTV) is a lung-protective strategy that reduces ventilator-induced lung injury in neonatal populations.

Purpose of the Study:

  • To determine the optimal tidal volume for VTV in infants with CDH.
  • To test the hypothesis that lower targeted tidal volumes are better for CDH infants.
  • To measure the work of breathing (WOB) in CDH infants at different VTV levels.

Main Methods:

  • A randomized cross-over study was conducted in infants after surgical repair of CDH.
  • Infants received VTV at targeted tidal volumes of 4, 5, and 6 ml/kg in random order.
  • Work of breathing was assessed using the pressure-time product of the diaphragm (PTPdi).

Main Results:

  • Nine infants with a median gestational age of 38 weeks were studied.
  • The PTPdi was significantly higher at a VTV of 4 ml/kg compared to 5 ml/kg (p=0.008) and 6 ml/kg (p=0.012).
  • A VTV of 5 ml/kg significantly reduced the work of breathing compared to lower VTV levels.

Conclusions:

  • VTV of 4 ml/kg should be avoided in post-surgical CDH infants due to increased work of breathing.
  • A VTV of 5 ml/kg appears to be a more appropriate target volume for VTV in this population.
  • Further research may be needed to establish definitive VTV guidelines for CDH infants.

Keywords:
Congenital diaphragmatic herniaPressure time productVolume targeted ventilationWork of breathing

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