Effect of surgical repair on respiratory mechanics in congenital diaphragmatic hernia
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Surgical repair of congenital diaphragmatic hernia (CHD) often worsens respiratory mechanics in infants, contrary to expectations. This study suggests a reevaluation of urgent surgical interventions for CHD is necessary.
Area of Science:
- Pediatric Surgery
- Neonatology
- Respiratory Physiology
Background:
- Congenital diaphragmatic hernia (CHD) is a serious condition requiring surgical intervention.
- The impact of surgical repair on infant respiratory mechanics is not fully understood.
Purpose of the Study:
- To assess changes in respiratory system compliance following surgical repair of CHD.
- To evaluate the relationship between respiratory mechanics and patient outcomes after CHD surgery.
Main Methods:
- Noninvasive measurement of respiratory system compliance using the passive expiratory flow-volume technique.
- Measurements were taken before and immediately after surgical repair in nine infants with CHD.
Main Results:
- Only one of nine infants showed immediate improvement in respiratory compliance post-surgery.
- Seven infants experienced a significant decrease in compliance after surgical repair.
- A decrease in compliance greater than 50% was associated with mortality due to hypoxemia and acidosis.
Conclusions:
- Surgical repair of congenital diaphragmatic hernia frequently leads to deterioration, not improvement, in respiratory mechanics.
- The findings challenge the current approach to urgent surgical repair for CHD.
- Reevaluation of the timing and necessity of surgical intervention for CHD is recommended.
Abstract:
To determine whether surgical repair of congenital diaphragmatic hernia (CHD) results in improvement in respiratory mechanics, we measured respiratory system compliance in nine patients (five survivors and four nonsurvivors) before and after operation. In all nine infants, CHD was diagnosed within 6 hours of life, and surgical repair was through an abdominal approach after a period of stabilization. Measurements were made noninvasively, using the passive expiratory flow-volume technique. In only one of the nine infants did compliance immediately improve after surgical repair, and in another it showed no change. Both of these infants survived, with an uneventful postoperative course. In the remaining seven infants, however, postoperative compliance immediately decreased to 10% to 77% from the preoperative value. The four infants with more than 50% decrease in compliance died with increasing hypoxemia and acidosis. These results suggest that respiratory mechanics in CHD, far from improving, frequently deteriorate as a result of repair of the hernia. The role of urgent surgery in this malformation should be reevaluated.