Subscribe to RSS
High-Frequency Positive Pressure Ventilation as Primary Rescue Strategy for Patients with Congenital Diaphragmatic Hernia: A Comparison to High-Frequency Oscillatory VentilationFunding None.
Objective The aim of this article was to evaluate high-frequency positive pressure ventilation (HFPPV) compared with high-frequency oscillatory ventilation (HFOV) as a rescue ventilation strategy for patients with congenital diaphragmatic hernia (CDH). HFPPV is a pressure-controlled conventional ventilation method utilizing high respiratory rate and low positive end-expiratory pressure.
Study Design Seventy-seven patients diagnosed with CDH from January 2005 to September 2019 who were treated with stepwise progression from HFPPV to HFOV versus only HFOV were included. Fisher's exact test and the Kruskal–Wallis test were used to compare outcomes.
Results Patients treated with HFPPV + HFOV had higher survival to discharge (80 vs. 50%, p = 0.007) and to surgical intervention (95.6 vs. 68.8%, p = 0.003), with average age at repair 2 days earlier (p = 0.004). Need for extracorporeal membrane oxygenation (p = 0.490), inhaled nitric oxide (p = 0.585), supplemental oxygen (p = 0.341), and pulmonary hypertension medications (p = 0.381) were similar.
Conclusion In CDH patients who fail respiratory support with conventional ventilation, HFPPV may be used as an intermediary mode of rescue ventilation prior to HFOV without adverse effects.
HFPPV may be used as an intermediary mode of rescue ventilation prior to HFOV without adverse effect.
HFPPV is more widely available and can mitigate the limitations faced when using HFOV.
HFPPV allows for intra- or interhospital transfer of neonates with CDH.
Keywordscongenital diaphragmatic hernia - high-frequency oscillatory ventilation - high-frequency positive pressure ventilation - mechanical ventilation - pulmonary hypertension - extracorporeal membrane oxygenation
Ethics Approval and Consent to Participate
This study was approved by Columbia University's institutional review board.
Human Research Disclosures
Research was conducted in accordance with the ethical standards of all applicable national and institutional committees and the World Medical Association's Helsinki Declaration.
C. G. designed the study, collected data, and wrote the manuscript; A. W.-S. designed the study, collected data, and made significant contributions to the manuscript; L. S. collected data and made significant edits to the manuscript; J. P. collected data and made significant edits to the manuscript; S. K. collected data and made significant edits to the manuscript; W. F. performed statistical analysis and made significant edits to the manuscript; R. H. helped design study and made significant edits to the manuscript; J. W. helped design study and made significant edits to the manuscript; R. S. helped design study and made significant edits to the manuscript; A. P. helped design study and made significant edits to the manuscript; V. D. designed study, assisted in the initial draft of the manuscript, and made significant edits.
Received: 26 May 2021
Accepted: 08 October 2021
Article published online:
16 December 2021
© 2021. Thieme. All rights reserved.
Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA
- 1 Puri P. Congenital diaphragmatic hernia and eventration. In: Puri P, Hollwarth M. eds. Pediatric Surgery. Berlin, Heidelberg: Springer; 2019: 95-100
- 2 Lally KP. Congenital diaphragmatic hernia. Curr Opin Pediatr 2002; 14 (04) 486-490
- 3 Harting MT, Lally KP. The congenital diaphragmatic hernia study group registry update. Semin Fetal Neonatal Med 2014; 19 (06) 370-375
- 4 Logan JW, Cotten CM, Goldberg RN, Clark RH. Mechanical ventilation strategies in the management of congenital diaphragmatic hernia. Semin Pediatr Surg 2007; 16 (02) 115-125
- 5 van den Hout L, Tibboel D, Vijfhuize S, te Beest H, Hop W, Reiss I. CDH-EURO Consortium. The VICI-trial: high frequency oscillation versus conventional mechanical ventilation in newborns with congenital diaphragmatic hernia: an international multicentre randomized controlled trial. BMC Pediatr 2011; 11: 98
- 6 Bhuta T, Clark RH, Henderson-Smart DJ. Rescue high frequency oscillatory ventilation vs conventional ventilation for infants with severe pulmonary dysfunction born at or near term. Cochrane Database Syst Rev 2001; (01) CD002974
- 7 Henderson-Smart DJ, Cools F, Bhuta T, Offringa M. Elective high frequency oscillatory ventilation versus conventional ventilation for acute pulmonary dysfunction in preterm infants. Cochrane Database Syst Rev 2007; (03) CD000104
- 8 deLemos R, Yoder B, McCurnin D, Kinsella J, Clark R, Null D. The use of high-frequency oscillatory ventilation (HFOV) and extracorporeal membrane oxygenation (ECMO) in the management of the term/near term infant with respiratory failure. Early Hum Dev 1992; 29 (1–3): 299-303
- 9 Sakurai Y, Azarow K, Cutz E, Messineo A, Pearl R, Bohn D. Pulmonary barotrauma in congenital diaphragmatic hernia: a clinicopathological correlation. J Pediatr Surg 1999; 34 (12) 1813-1817
- 10 Areechon W, Reid L. Hypoplasia of lung with congenital diaphragmatic hernia. BMJ 1963; 1 (5325): 230-233
- 11 Berdon WE, Baker DH, Amoury R. The role of pulmonary hypoplasia in the prognosis of newborn infants with diaphragmatic hernia and eventration. Am J Roentgenol Radium Ther Nucl Med 1968; 103 (02) 413-421
- 12 Kitagawa M, Hislop A, Boyden EA, Reid L. Lung hypoplasia in congenital diaphragmatic hernia. A quantitative study of airway, artery, and alveolar development. Br J Surg 1971; 58 (05) 342-346
- 13 Naeye RL, Shochat SJ, Whitman V, Maisels MJ. Unsuspected pulmonary vascular abnormalities associated with diaphragmatic hernia. Pediatrics 1976; 58 (06) 902-906
- 14 Levin DL. Morphologic analysis of the pulmonary vascular bed in congenital left-sided diaphragmatic hernia. J Pediatr 1978; 92 (05) 805-809
- 15 Geggel RL, Murphy JD, Langleben D, Crone RK, Vacanti JP, Reid LM. Congenital diaphragmatic hernia: arterial structural changes and persistent pulmonary hypertension after surgical repair. J Pediatr 1985; 107 (03) 457-464
- 16 Sakai H, Tamura M, Hosokawa Y, Bryan AC, Barker GA, Bohn DJ. Effect of surgical repair on respiratory mechanics in congenital diaphragmatic hernia. J Pediatr 1987; 111 (03) 432-438
- 17 Nakayama DK, Motoyama EK, Tagge EM. Effect of preoperative stabilization on respiratory system compliance and outcome in newborn infants with congenital diaphragmatic hernia. J Pediatr 1991; 118 (05) 793-799
- 18 Wung JT, Sahni R, Moffitt ST, Lipsitz E, Stolar CJ. Congenital diaphragmatic hernia: survival treated with very delayed surgery, spontaneous respiration, and no chest tube. J Pediatr Surg 1995; 30 (03) 406-409
- 19 Desfrere L, Jarreau PH, Dommergues M. et al. Impact of delayed repair and elective high-frequency oscillatory ventilation on survival of antenatally diagnosed congenital diaphragmatic hernia: first application of these strategies in the more “severe” subgroup of antenatally diagnosed newborns. Intensive Care Med 2000; 26 (07) 934-941
- 20 Ivascu FA, Hirschl RB. New approaches to managing congenital diaphragmatic hernia. Semin Perinatol 2004; 28 (03) 185-198
- 21 Miguet D, Claris O, Lapillonne A, Bakr A, Chappuis JP, Salle BL. Preoperative stabilization using high-frequency oscillatory ventilation in the management of congenital diaphragmatic hernia. Crit Care Med 1994; 22 (9, Suppl): S77-S82
- 22 Migliazza L, Bellan C, Alberti D. et al. Retrospective study of 111 cases of congenital diaphragmatic hernia treated with early high-frequency oscillatory ventilation and presurgical stabilization. J Pediatr Surg 2007; 42 (09) 1526-1532
- 23 Ng GY, Derry C, Marston L, Choudhury M, Holmes K, Calvert SA. Reduction in ventilator-induced lung injury improves outcome in congenital diaphragmatic hernia?. Pediatr Surg Int 2008; 24 (02) 145-150
- 24 Somaschini M, Locatelli G, Salvoni L, Bellan C, Colombo A. Impact of new treatments for respiratory failure on outcome of infants with congenital diaphragmatic hernia. Eur J Pediatr 1999; 158 (10) 780-784
- 25 Cacciari A, Ruggeri G, Mordenti M. et al. High-frequency oscillatory ventilation versus conventional mechanical ventilation in congenital diaphragmatic hernia. Eur J Pediatr Surg 2001; 11 (01) 3-7
- 26 van den Hout L, Reiss I, Felix JF. et al; Congenital Diaphragmatic Hernia Study Group. Risk factors for chronic lung disease and mortality in newborns with congenital diaphragmatic hernia. Neonatology 2010; 98 (04) 370-380
- 27 Snoek KG, Capolupo I, van Rosmalen J. et al. Conventional mechanical ventilation versus high-frequency oscillatory ventilation for congenital diaphragmatic hernia: a randomized clinical trial (the VICI-trial). Ann Surg 2016; 263 (05) 867-874
- 28 Branson RD, Griebel J, Rodriquez Jr D. A bench study of inhaled nitric oxide delivery during high frequency percussive ventilation. Pediatr Pulmonol 2018; 53 (03) 337-341
- 29 Krishnan JA, Brower RG. High-frequency ventilation for acute lung injury and ARDS. Chest 2000; 118 (03) 795-807
- 30 Standiford TJ, Morganroth ML. High-frequency ventilation. Chest 1989; 96 (06) 1380-1389
- 31 Borg U, Eriksson I, Sjøstrand U. High-frequency positive-pressure ventilation (HFPPV): a review based upon its use during bronchoscopy and for laryngoscopy and microlaryngeal surgery under general anesthesia. Anesth Analg 1980; 59 (08) 594-603
- 32 Heijman K, Heijman L, Jonzon A, Sedin G, Sjöstrand U, Widman B. High frequency positive pressure ventilation during anaesthesia and routine surgery in man. Acta Anaesthesiol Scand 1972; 16 (03) 176-187
- 33 Beresford MW, Shaw NJ. Outcome of congenital diaphragmatic hernia. Pediatr Pulmonol 2000; 30 (03) 249-256
- 34 Akinkuotu AC, Cruz SM, Cass DL. et al. Revisiting outcomes of right congenital diaphragmatic hernia. J Surg Res 2015; 198 (02) 413-417
- 35 Sreenan C, Etches P, Osiovich H. The western Canadian experience with congenital diaphragmatic hernia: perinatal factors predictive of extracorporeal membrane oxygenation and death. Pediatr Surg Int 2001; 17 (2–3): 196-200
- 36 Alfaraj MA, Shah PS, Bohn D. et al. Congenital diaphragmatic hernia: lung-to-head ratio and lung volume for prediction of outcome. Am J Obstet Gynecol 2011; 205 (01) 43.e1-43.e8
- 37 Guibaud L, Filiatrault D, Garel L. et al. Fetal congenital diaphragmatic hernia: accuracy of sonography in the diagnosis and prediction of the outcome after birth. AJR Am J Roentgenol 1996; 166 (05) 1195-1202
- 38 Oluyomi-Obi T, Kuret V, Puligandla P. et al. Antenatal predictors of outcome in prenatally diagnosed congenital diaphragmatic hernia (CDH). J Pediatr Surg 2017; 52 (05) 881-888
- 39 Usui N, Okuyama H, Sawai T, Kamiyama M, Kamata S, Fukuzawa M. Relationship between L/T ratio and LHR in the prenatal assessment of pulmonary hypoplasia in congenital diaphragmatic hernia. Pediatr Surg Int 2007; 23 (10) 971-976
- 40 Straňák Z, Krofta L, Haak LA. et al. Antenatal assessment of liver position, rather than lung-to-head ratio (LHR) or observed/expected LHR, is predictive of outcome in fetuses with isolated left-sided congenital diaphragmatic hernia. J Matern Fetal Neonatal Med 2017; 30 (01) 74-78
- 41 Miller AG, Bartle RM, Rehder KJ. High-frequency jet ventilation in neonatal and pediatric subjects: a narrative review. Respir Care 2021; 66 (05) 845-856
- 42 Zhang Q, Macartney J, Sampaio L, O'Brien K. High frequency jet ventilation during initial management, stabilization, and transport of newborn infants with congenital diaphragmatic hernia: a case series. Crit Care Res Pract 2013; 2013: 937871