Ventilation and Spontaneous Breathing at Birth of Infants with Congenital Diaphragmatic Hernia
Received 15 May 2008; received in revised form 25 July 2008; accepted 12 September 2008. published online 28 November 2008.
Objective
To describe the interaction of spontaneous breaths, manual ventilation, and tidal volumes (VT) during stabilization of infants with congenital diaphragmatic hernia (CDH) in the delivery room.
Study design
We studied infants with CDH receiving respiratory support at birth. Airway pressure, flow, and volume were measured, and each breath or inflation was analyzed. Each VT was classified as a manual inflation, a spontaneous breath, or a spontaneous breath coinciding with manual inflation on the basis of the timing of the pressure and flow waves.
Results
Twelve infants had 2957 breaths suitable for analysis, with spontaneous breathing in 11 infants (92%). The mean (±SD) proportion of manual inflations was 41% (±24%), spontaneous breaths 43% (±25%), spontaneous but coinciding with manual inflation 16% (±12%). VT was significantly different for spontaneous breaths (3.8 ± 1.9 mL/kg), spontaneous breaths coinciding with manual inflation (4.7 ± 2.5 mL/kg), and manual inflations alone (2.6 ± 1.6 mL/kg).
Conclusions
Most infants with CDH breathed spontaneously, and manual ventilation was mostly asynchronous. We observed large differences in tidal volumes between spontaneous breaths, manual inflations, or where these coincided, with manual inflations having the lowest VT. Monitoring the respiratory pattern of these infants could improve respiratory support.
aDivision of Newborn Services, Royal Women's Hospital, Victoria, Australia
bDivision of Neonatology, Department of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands
cDepartment of Neonatology, National Maternity Hospital, Dublin, Ireland
Reprint requests: Arjan B. te Pas, MD, Division of Neonatology, Department of Pediatrics, Leiden University Medical Center, J6-S, P.O. Box 9600, 2300 RC Leiden, The Netherlands
C.O.F.K., J.D., and A.t.P., have been beneficiaries of the Royal Women's Hospital Postgraduate Degree Scholarship. P.G.D., is partly supported by a National Health and Medical Research Council Fellowship. The authors declare no conflicts of interest.
ABSTRACT