Abstract：
BACKGROUND: Infants with congenital diaphragmatic hernia (CDH) experience high morbidity and mortality due to pulmonary arterial hypertension and hypoplasia. Mechanical ventilation is a central component of CDH management. Our objective was to evaluate the impact of a standardized clinical practice guideline (implemented in January 2012) on ventilator management for infants with CDH, and associate management changes with short-term outcomes, specifically extracorporeal membrane oxygenation (ECMO) utilization and survival to discharge.
METHODS: We conducted a retrospective pre-post study of 103 CDH infants admitted from January 2007-July 2021, divided pre- (n = 40) and post-guideline (n = 63). Clinical outcomes, ventilator settings, and blood gas values in the first 7 days of mechanical ventilation were compared between the pre- and post-guideline cohorts.
RESULTS: Post-guideline, ECMO utilization decreased (11% vs 38%, p = 0.001) and survival to discharge improved (92% vs 68%, p = 0.001). More post-guideline patients remained on conventional mechanical ventilation without need for escalation to high-frequency ventilation or ECMO, and had higher pressures and PaCO2 with lower FiO2 and PaO2 (p < 0.05).
CONCLUSIONS: Standardized ventilator management optimizing pressures for adequate lung expansion and minimizing oxygen toxicity improves outcomes for infants with CDH.
METHODS: III.
METHODS: We conducted a retrospective pre-post study of 103 CDH infants admitted from January 2007-July 2021, divided pre- (n = 40) and post-guideline (n = 63). Clinical outcomes, ventilator settings, and blood gas values in the first 7 days of mechanical ventilation were compared between the pre- and post-guideline cohorts.
RESULTS: Post-guideline, ECMO utilization decreased (11% vs 38%, p = 0.001) and survival to discharge improved (92% vs 68%, p = 0.001). More post-guideline patients remained on conventional mechanical ventilation without need for escalation to high-frequency ventilation or ECMO, and had higher pressures and PaCO2 with lower FiO2 and PaO2 (p < 0.05).
CONCLUSIONS: Standardized ventilator management optimizing pressures for adequate lung expansion and minimizing oxygen toxicity improves outcomes for infants with CDH.
METHODS: III.
摘要：
背景：患有先天性膈疝（CDH）的婴儿由于肺动脉高压和发育不全而具有很高的发病率和死亡率。机械通气是CDH管理的核心组成部分。我们的目标是评估标准化临床实践指南（2012年1月实施）对CDH婴儿呼吸机管理的影响。并将管理变化与短期结果联系起来，特别是体外膜氧合（ECMO）的利用和生存排放。
方法：我们对2007年1月至2021年7月收治的103名CDH婴儿进行了回顾性研究，分为指南前（n=40）和指南后（n=63）。临床结果,呼吸机设置,在指南前和指南后队列中,比较了机械通气前7天的血气值.
结果：指南后，ECMO利用率下降(11%对38%，p=0.001），出院存活率提高（92%vs68%，p=0.001)。更多的指南后患者仍在常规机械通气，不需要升级到高频通气或ECMO。并且具有较高的压力和PaCO2，具有较低的FiO2和PaO2（p<0.05）。
结论：优化压力以实现充分的肺扩张和最小化氧毒性的标准化呼吸机管理可改善CDH婴儿的结局。
方法：III.
方法：我们对2007年1月至2021年7月收治的103名CDH婴儿进行了回顾性研究，分为指南前（n=40）和指南后（n=63）。临床结果,呼吸机设置,在指南前和指南后队列中,比较了机械通气前7天的血气值.
结果：指南后，ECMO利用率下降(11%对38%，p=0.001），出院存活率提高（92%vs68%，p=0.001)。更多的指南后患者仍在常规机械通气，不需要升级到高频通气或ECMO。并且具有较高的压力和PaCO2，具有较低的FiO2和PaO2（p<0.05）。
结论：优化压力以实现充分的肺扩张和最小化氧毒性的标准化呼吸机管理可改善CDH婴儿的结局。
方法：III.
