Pediatr Pulmonol

. 2024 Jan 11.

 doi: 10.1002/ppul.26789. Online ahead of print. https://pubmed.ncbi.nlm.nih.gov/38206041/

Respiratory function testing for guiding ventilator mode conversion in congenital diaphragmatic hernia

Sasagu Kimura ^1 2, Katsuaki Toyoshima ¹, Tomoyuki Shimokaze ¹, Kaoru Katsumata ¹, Tomoko Saito ¹, Rikuo Hoshino ¹

Affiliations expand

• PMID: 38206041
• DOI: 10.1002/ppul.26789

Abstract

Introduction: For patients with a congenital diaphragmatic hernia, conventional mechanical ventilation (CMV) and high-frequency oscillatory ventilation (HFOV) are used in initial ventilatory management. HFOV has recently been recommended as a rescue therapy; however, we use HFOV for initial ventilation management, with a preoperative challenge test for CMV conversion and respiratory function testing at the time of CMV conversion. We aimed to compare patient characteristics between CMV conversion- and HFOV-preferred treatment groups.

Methods: Ventilator settings and blood gases were retrospectively evaluated pre- and post-CMV conversion, and respiratory function tests for compliance of the respiratory system (Crs) and for resistance of the respiratory system (Rrs) were performed during the trial to CMV conversion.

Results: No differences were observed between the CMV conversion- and HFOV-preferred groups regarding gestational age, birth weight, and observed/expected lung area-to-head circumference ratios. The median Crs (ml/cmH₂ O/kg) and Rrs (cmH₂ O･kg/L/s) in the CMV conversion- and HFOV-preferred groups was 0.42 versus 0.53 (p = .44) and 467 versus 327 (p = .045), respectively. The pre and posttrial amount of change in blood gas levels and ventilator parameters in the CMV conversion- and HFOV-preferred groups were as follows: mean airway pressure, -2.0 versus 0 cmH₂ O; partial pressure of carbon dioxide, 6.1 versus 2.9 Torr; alveolar-arterial oxygen difference, -39.5 versus -50 Torr; and oxygenation index, -1.0 versus -0.6; respectively.

Conclusion: Respiratory function tests were useful in tailoring ventilator settings. Patients with high Rrs values responded better to CMV conversion.

Keywords: compliance; conventional mechanical ventilation; high-frequency oscillatory ventilation; persistent pulmonary hypertension of the newborn; resistance.

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