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- Title
Intraoperative ventilation during thoracoscopic repair of neonatal congenital diaphragmatic hernia.
- Authors
Okazaki, Tadaharu; Okawada, Manabu; Ishii, Junya; Koga, Hiroyuki; Miyano, Go; Doi, Takashi; Ogasawara, Yuki; Lane, Geoffrey; Yamataka, Atsuyuki; Lane, Geoffrey J
- Abstract
<bold>Purpose: </bold>To evaluate the optimal ventilation mode during thoracoscopic repair (TR) of neonatal congenital diaphragmatic hernia (CDH), we compared high-frequency oscillatory ventilation (HFOV) with conventional mechanical ventilation (CMV).<bold>Methods: </bold>Twenty-three neonatal CDH cases who underwent TR without intraoperative inhalation of nitric oxide at our institution between 2007 and 2016 were reviewed. Patients were initially ventilated with HFOV, which was converted to CMV if the HFOV settings were decreased to FiO2 <0.4, stroke volume <4 mL/kg and mean airway pressure <12 cmH2O. Arterial blood gases in the perioperative period were compared between HFOV and CMV.<bold>Results: </bold>Seventeen patients were ventilated with HFOV (group I), and six patients were ventilated with CMV (group II). Preoperative PaCO2 was significantly higher and pH was significantly lower in group I compared with group II. In both groups I and II, intraoperative PaCO2 increased significantly and pH decreased significantly compared with preoperation. Although intraoperative PaCO2 and pH were not different between the groups, group II showed greater worsening of intraoperative PaCO2 and pH as compared to their respective preoperative values.<bold>Conclusions: </bold>HFOV seems to prevent deterioration of hypercapnia and acidosis to a greater extent than CMV during TR in neonatal cases of CDH, although patients can also be ventilated with CMV.
- Subjects
INTRAOPERATIVE care; NONINVASIVE ventilation; THORACOSCOPY; HERNIA surgery; NITRIC oxide; DIAPHRAGMATIC hernia; ARTIFICIAL respiration; BLOOD gases analysis; GENETIC disorders; SURGERY
- Publication
Pediatric Surgery International, 2017, Vol 33, Issue 10, p1097
- ISSN
0179-0358
- Publication type
journal article
- DOI
10.1007/s00383-017-4143-y