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Am J Perinatol 2014; 31(11): 939-946
DOI: 10.1055/s-0034-1368088
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

The Value of Paco 2 in Relation to Outcome in Congenital Diaphragmatic Hernia

Ariel A. Salas
1   Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama
,
Ramachandra Bhat
1   Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama
,
Katarzyna Dabrowska
1   Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama
,
Alicia Leadford
1   Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama
,
Scott Anderson
2   Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama
,
Carroll M. Harmon
2   Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama
,
Namasivayam Ambalavanan
1   Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama
,
George T. El-Ferzli
1   Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama
› Author Affiliations
Further Information

Publication History

11 August 2013

17 December 2013

Publication Date:
10 February 2014 (online)

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Abstract

Background Postnatal assessment of disease severity is critical for analysis of mortality rates and development of future interventions in congenital diaphragmatic hernia (CDH).

Objective The objective of this study was to stratify the risk of mortality based on arterial Paco 2.

Methods Retrospective analysis of infants (n = 133) with CDH admitted to a regional extracorporeal membrane oxygenation (ECMO) center in two different periods: period I (1987–1996; n = 46) and period II (2002–2010; n = 87).

Results The mortality rate (37%) was similar in both periods (p = 0.98). Paco 2 < 60 mm Hg in the first arterial blood gas (ABG) was an independent predictor of survival in both periods (p = 0.03). The predicted survival rate was 84% if initial Paco 2 was < 55 mm Hg. For infants with initial Paco 2 > 55 mm Hg treated with ECMO (n = 83), the predicted survival rate was 11% if the Paco 2 was > 88 mm Hg before the initiation of ECMO.

Conclusion Paco 2, a surrogate of lung hypoplasia, may be useful for risk stratification in CDH. Paco 2 < 60 mm Hg in the first ABG may indicate milder pulmonary hypoplasia. A Paco 2 > 80 mm Hg in the first ABG and/or before ECMO may indicate severe pulmonary hypoplasia.

Keywords

extracorporeal membrane oxygenation - risk assessment - risk stratification - gentle ventilation - permissive hypercapnia - severity of disease - mortality
 

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