Pediatr Surg Int

. 2020 Sep 16. doi: 10.1007/s00383-020-04740-x. Online ahead of print. https://pubmed.ncbi.nlm.nih.gov/32939579/

High-frequency vs. conventional ventilation at the time of CDH repair is not associated with higher mortality and oxygen dependency: a retrospective cohort study

Gabrielle Derraugh ¹, Matthew Levesque ¹, Daryl Schantz ², Molly Sesha ³, John Minski ⁴, John Baier ³, Melanie I Morris ¹, Anna C Shawyer ¹, Robert Balshaw ⁵, Suyin A Lum Min ¹, Richard Keijzer ⁶Affiliations expand

• PMID: 32939579
• DOI: 10.1007/s00383-020-04740-x

Abstract

Purpose: The VICI-trial reported that in patients with congenital diaphragmatic hernia (CDH), mortality or bronchopulmonary dysplasia (BPD) were equivalent using conventional mechanical ventilation (CMV) and high-frequency oscillatory ventilation. The purpose of this study was to determine if the mode of ventilation at the time of CDH repair affected mortality or oxygen dependence at 28 days.

Methods: We performed a retrospective cohort study of infants born wih CDH from 1991 to 2015. A generalized linear model was applied to the data using a propensity score analysis.

Results: Eighty patients met the inclusion criteria; at the time of surgery 39 (48.8%) patients were on HFV and 41 (51.3%) patients were on CMV. In the HFV group, 16 (47.1%) patients remained oxygen dependent and there were 5 (12.8%) deaths at 28 days. In the CMV group, 5 (12.2%) patients remained oxygen dependent at 28 days but none had died. The base model demonstrated that the HFV group had increased rates of oxygen dependence [OR = 6.40 (2.13, 22.2), p = 0.002]. However, after propensity score analysis, we found no difference between HFV and CMV.

Conclusion: Our study suggests that in infants with CDH, there is no significant difference between HFV and CMV in oxygen dependency or death.

Keywords: Congenital diaphragmatic hernia (CDH); Conventional mechanical ventilation (CMV); High-frequency jet ventilation (HFJV); High-frequency oscillatory ventilation (HFOV); High-frequency ventilation (HFV); Ventilator induced lung injury.