Congenital Diaphragmatic Hernia
Abstract
Introduction. The Congenital Diaphragmatic Hernia (CDH) is an anatomical structural defect, which allows passage of the abdominal viscera into the chest cavity resulting in morbidity from serious cardiopulmonary complications and high perioperative mortality. In the last few decades new management strategies have been developed that have helped to reduce this high mortality.
Objectives. To review and analyze a clinical CDH case and its perioperative evolution, including a discussion about anesthetic and respiratory management, in addition to reviewing the latest literature on the topic.
Methodology. Presentation of a clinical case
Conclusions. The management of a CDH patient is multidisciplinary. An early diagnosis should be made from the pre-natal period in order to optimize management and make available the best therapeutic tools. However, despite our efforts, mortality is still high.
This is a patient –35 hours after birth– presenting congenital diaphragmatic hernia and at birth was managed at the neonatal intensive care unit with freorotracheal intubation, assisted mechanical ventilation, and inotropic and vasopressor support. Then the patient was taken to the OR to undergo corrective surgery for the diaphragmatic defect. The anesthetic and respiratory management is discussed together with a brief literature review.
References
2. Coté Ch J. Anestesia pediátrica: Anestesia para cirugía pediátrica y neonatal. En: Miller R. Anestesia de Miller. 5a ed. Madrid: Elsevier; 2005. p. 2396-97.
3. Steinhorn RH. Congenital diaphragmatic hernia Internet. Omaha: E-medicine; 2009. citado 2008 Ene 20 Disponible en: http://emedicine.medscape.com/article/978118-overviewe.
4. Holder AM, Klaassens M, Tibboel D, de Klein A, Lee B, Scott DA. Genetic factors in congenital diaphragmatic hernia. Am J Hum Genet. 2007;80(5):825-45.
5. De Lorimier AA, Tierney DF, Parker HR. Hypoplastic lungs in fetal lambs in surgically produced congenital diaphragmatic hernia. Surgery. 1967;62:12-7.
6. Narayan H, De Chazal R, Barrow M, McKeever P, Neale E. Familial congenital diaphragmatic hernia: prenatal diagnosis, management, and outcome. Prenat Diagn. 1993;13(10):893-901.
7. Hedrick HL, Adzick NS. Congenital diaphragmatic hernia: Prenatal diagnosis and management. In: Rose BD (editor), UpToDate in medicine. Wellesley: UpToDate; 2009.
8. Lewis N, Glick PL. Diaphragmatic hernias Internet. Omaha: E-medicine; 2008. citado 2008 Jun 2. Disponible en: http://emedicine.medscape.com/article/934824-overview.
9. Hansen TN, Corbet A, Ballard RA. Disorders of the chest wall, pleural cavity, and diaphragm. In: Taeusch HW, Ballard RA, Gleason CA (editors). Avery´s Diseases of the Newborn. 8th Ed. Philadelphia: WB Saunders; 2005. p. 759-78.
10. Graham G, Devine PC. Antenatal diagnosis of congenital diaphragmatic hernia. Semin Perinatol. 2005;29(2):69-76.
11. 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(3):406-9.
12. Logan JW, Rice HE, Goldberg RN, Cotten CM. Congenital diaphragmatic hernia: a systematic review and summary of best-evidence practice strategies. J Perinatol. 2007;27(9):535-49.
13. Lally KP, Paranka MS, Roden J, Georgeson K E, Wilson J M, Lillehei C W, et al. Congenital diaphragmatic hernia. Stabilization and repair on ECMO. Ann Surg. 1992;216(5):569-73.
14. Gaxiola A, Varon J, Valladolid G. Congenital diaphragmatic hernia: an overview of the etiology and current management. Acta Paediatr. 2009;98(4):621-7.
15. Saura L, Castanon M, Prat J, Albert A, Caceres F, Moreno J, et al. Impact of fetal intervention on postnatal management of congenital diaphragmatic hernia. Eur J Pediatr Surg. 2007;17(6):404-7.
16. Chiu PP, Sauer C, Mihailovic A, Adatia I, Bohn D, Coates AL, et al. The price of success in the management of congenital diaphragmatic hernia: is improved survival accompanied by an increase in longterm morbidity? J Pediatr Surg. 2006;41(5):888-92.
17. Chess PR. The effect of gentle ventilation on survival in congenital diaphragmatic hernia. Pediatrics. 2004;113(4):917.
18. Datin-Dorriere V, Walter-Nicolet E, Rousseau V, Taupin P, Benachi A, Parat S, et al. Experience in the management of eighty-two newborns with congenital diaphragmatic hernia treated with high-frequency oscillatory ventilation and delayed surgery without the use of extracorporeal membrane oxygenation. J Intensive Care Med. 2008;23(2):128-35.
19. 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(2):145-50.
20. Lally KP. Extracorporeal membrane oxygenation in patients with congenital diaphragmatic hernia. Semin Pediatr Surg. 1996;5(4):249-55.
21. Glick PL, Leach CL, Besner GE, Egan EA, Morin FC, Malanowska-Kantoch A, et al. Pathophysiology of congenital diaphragmatic hernia. III: Exogenous surfactant therapy for the high-risk neonate with CDH. J Pediatr Surg. 1992;27(7):866-9.
22. Extracorporeal Life Support Organization (ELSO). Patient Specific Supplements to the ELSO General Guidelines April 2009 Internet. Ann Arbor: Extracorporeal Life Support Organization; 2009. citado 2010 Ene 28. Disponible en: http://www. elso.med. umich.edu/Guidelines.html
23. Conrad SA, Rycus PT, Dalton H. Extracorporeal Life Support Registry Report 2004. ASAIO J. 2005;51(1):4- 10.
24. Frenckner BP, Lally PA, Hintz SR, Lally KP; Congenital Diaphragmatic Hernia Study Group. Prenatal diagnosis of congenital diaphragmatic hernia: how should the babies be delivered? J Pediatr Surg. 2007;42(9):1533-8.
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