Review: Anatomical deadspace during resuscitation of infants with congenital diaphragmatic hernia

Early Hum Dev

. 2020 Jul 29;149:105150. doi: 10.1016/j.earlhumdev.2020.105150. Online ahead of print.

Anatomical deadspace during resuscitation of infants with congenital diaphragmatic hernia

Emma E Williams 1Theodore Dassios 2Vadivelam Murthy 3Anne Greenough 4Affiliations expand


Background: Congenital diaphragmatic hernia (CDH) has a high mortality and morbidity related to pulmonary hypoplasia.

Aims: To test the hypothesis that CDH infants who survived would have a greater anatomical deadspace reflecting less severe pulmonary hypoplasia. Furthermore, infants with CDH who had undergone feto-tracheal occlusion (FETO) would have a greater anatomical deadspace.

Study design: Infants were studied during resuscitation in the delivery suite. They were all intubated immediately at delivery, given a neuromuscular blocking agent and underwent respiratory monitoring. The anatomical deadspace was calculated from volumetric capnography measurements.

Subjects: Thirty infants born at 32 weeks of gestation or greater and diagnosed antenatally with a CDH were studied. Eleven had undergone FETO and overall five died.

Outcome measures: Anatomical deadspace (VdANA) and survival to discharge.

Results: The median (IQR) gestational age of the infants was 38.1 (35.2-39.3) weeks and birthweight 2.8 (2.3-3.3) kg. The anatomical deadspace was higher in those infants who survived (2.9 (2.8-3.3) mls/kg) compared to those who died (2.2 (2.1-2.7) mls/kg; p = 0.003) and was higher in those who had undergone FETO (3.0 (2.8-3.8) mls/kg) compared to those who had not (2.8 (2.4-3.0) mls/kg; p = 0.032). In predicting survival to discharge, the anatomical deadspace had an AUC of 0.90 (p = 0.006).

Conclusions: CDH infants who survived had a larger anatomical deadspace than those who died suggesting they had less lung hypoplasia. In addition, infants who had undergone FETO had greater anatomical deadspace possibly reflecting distension of the conducting airways.

Keywords: Anatomical deadspace; Congenital diaphragmatic hernia; Feto-tracheal occlusion; Resuscitation.

Copyright © 2020 Elsevier B.V. All rights reserved.

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