464 - Is Really Not Available A Lung Volume Optimization Maneuver In Newborns With Congenital Diaphragmatic Hernia (CDH)? A Monocentric Observational Retrospective Study

Poster Number: 464
Publication Number: 464.229

Ilaria Cocchi, ASST-FBF-Sacco, Milan, Lombardia, Italy; Francesco Cavigioli, V.Buzzi Children's Hospital, milan, Lombardia, Italy; Enrica Lupo, Children’s Hospital, Milan, Lombardia, Italy; Francesca Castoldi, NICU V.Buzzi Children's Hospital, Milan, Lombardia, Italy; Valentina Pivetti, Children's Hospital Buzzi, Milan, Milano, Lombardia, Italy; Francesca Viaroli, NICU V.Buzzi Children's Hospital, Milan, Lombardia, Italy; Gianluca Lista, V.Buzzi Children's Hospital ASST-FBF-Sacco, Milan, Lombardia, Italy

Background: Lung volume optimization maneuver is a well-established approach in mechanically ventilated RDS preterm infants. In infants affected by Congenital Diaphragmatic Hernia (CDH) the achievement of a cardiorespiratory stability is needed for surgical repair. Before the infants need a cardiovascular pharmacological support and iNO therapy for a possible cardiac impairment with pulmonary hypertension, a ventilation strategy is crucial.  It may be useful to safely recruit part of non-hypoplastic lung in order to contribute to clinical stabilization.

Objective: To evaluate the efficacy of a lung volume optimization maneuver during HFOV in the first hours of life in CDH newborns on oxygenation improvement and timing to reach stable conditions for surgical repair.

Design/Methods: Monocentric observational retrospective study focusing on HFOV ventilation in term CDH newborns. Lung volume optimization maneuver was applied in mechanically ventilated term CDH infants (recruited group, GrR) with persistent need of FiO2 >50% with no signs of cardiovascular impairment (both systemic and pulmonary), to maintain pre-ductal SpO2 targets < 90% at NICU entry. Clinical characteristics, ventilator parameters and timing of surgical repair of GrR were compared with the group not undergoing the maneuver (GrNR). Descriptive statistics is provided with medians (μe) and interquartile ranges (IQR) or percentages as appropriate.

Results: 18 term CDH infants were studied: 12 (GrR) and 6 (GrNR). The two groups were similar in terms of clinical characteristics except for needs of FiO2 at NICU entry. In both groups left-CDH was prevalent (83.3%-GrR, 100%-GrNR). The maneuver lasted approximately 60 minutes. We collected data at t0 (NICU entry), at T30 (30' ) and at T60 (60' of the procedure). At t0 infants in GrR needed a higher FiO2 and a lower MAP than infants in GrNR (p=0.05). At T30 Mean blood pressure was significantly lower in the GrNR patients (38 mmHg, IQR 32–46 mmHg) compared to the GrR patients (54 mmHg, IQR 43–59) (p=0.008). 10/12 patients of GrR (83.3%) versus 2/6 of GrNR (33.3%) underwent surgical repair within 48 hours (p=0.005). Details in figures 1, 2 and 3.Conclusion(s): Lung volume optimization maneuver in severe CDH newborns, applied soon after birth before the eventual appearance of cardiovascular impairment, may help to identify the lowest and optimal MAP limiting overdistension. Thus, this strategy may lead to better cardiorespiratory stability favouring the achievement of stable conditions for surgery. These data need to be confirmed by larger RCTs.
Clinical Characteristics of the infants in the two groupsGrR group lung recruitment; GrNR group with no recruitment
Ventilatory and Oxygenation status of the enrolled infants in the first hour of life