High-Frequency Positive Pressure Ventilation as Primary Rescue Strategy for Patients with Congenital Diaphragmatic Hernia: A Comparison to High-Frequency Oscillatory Ventilation

Abstract

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.

Key Points

• 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.

Keywords

congenital diaphragmatic hernia - high-frequency oscillatory ventilation - high-frequency positive pressure ventilation - mechanical ventilation - pulmonary hypertension - extracorporeal membrane oxygenation

Ethical Approval

This study was approved by Columbia University's institutional review board. Research was conducted in accordance with the ethical standards of all applicable national and institutional committees and the World Medical Association's Helsinki Declaration.

Authors' Contributions

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.

Publication History

Received: 26 May 2021

Accepted: 08 October 2021

Article published online:
16 December 2021

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