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Journal of Perinatal Medicine

Official Journal of the World Association of Perinatal Medicine

Editor-in-Chief: Dudenhausen, MD, FRCOG, Joachim W.

Ed. by Bancalari, Eduardo / Chappelle, Joseph / Chervenak, Frank A. / D'Addario , Vincenzo / Genc, Mehmet R. / Greenough, Anne / Grunebaum, Amos / Konje, Justin C. / Kurjak M.D., Asim / Romero, Roberto / Zalud, MD PhD, Ivica


IMPACT FACTOR 2017: 1.558
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1619-3997
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Volume 45, Issue 9

Issues

A definition of gentle ventilation in congenital diaphragmatic hernia: a survey of neonatologists and pediatric surgeons

Christiana Farkouh-Karoleski / Tasnim Najaf / Julia Wynn / Gudrun Aspelund / Wendy K. Chung / Charles J. Stolar / George B. Mychaliska
  • Section of Pediatric Surgery, Fetal Diagnosis and Treatment Center, University of Michigan Health System, Ann Arbor, MI, USA
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/ Brad W. Warner / Amy J. Wagner
  • Division of Pediatric Surgery, Children’s Hospital of Wisconsin, Medical College of Wisconsin, Milwaukee, WI, USA
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/ Robert A. Cusick
  • Division of Pediatric Surgery, University of Nebraska Medical Center College of Medicine, Omaha, NE, USA
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/ Foong-Yen Lim
  • Division of Pediatric General, Thoracic, and Fetal Surgery, Center for Molecular Fetal Therapy, Cincinnati Children’s Hospital Medical Center, and Cincinnati, OH, USA
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/ David T. Schindel / Douglas Potoka
  • Department of Instruction and Learning – Early Intervention Program, University of Pittsburgh, Pittsburgh, PA, USA
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/ Kenneth Azarow
  • Pediatric Surgery Division, Department of Surgery, Oregon Health & Science University, Portland, OR, USA
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/ C. Michael Cotten
  • Department of Pediatrics, Division of Neonatology, Duke University School of Medicine, Durham, NC, USA
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/ Anthony Hesketh
  • Division of Pediatric Surgery, Steven and Alexandra Cohen Children’s Hospital, New Hyde Park, NY, USA
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/ Samuel Soffer
  • Division of Pediatric Surgery, Steven and Alexandra Cohen Children’s Hospital, New Hyde Park, NY, USA
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/ Timothy Crombleholme
  • Colorado Fetal Care Center, Division of Pediatric General, Thoracic, and Fetal Surgery, Children’s Hospital Colorado Aurora, CO, USA and the University of Colorado School of Medicine, Aurora, CO, USA
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/ Howard Needelman
  • Department of Pediatrics, Division of Behavior and Development, University of Nebraska Medical Center College of Medicine, Omaha, NE, USA
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Published Online: 2017-01-28 | DOI: https://doi.org/10.1515/jpm-2016-0271

Abstract

Ventilation practices have changed significantly since the initial reports in the mid 1980 of successful use of permissive hypercapnia and spontaneous ventilation [often called gentle ventilation (GV)] in infants with congenital diaphragmatic hernia (CDH). However, there has been little standardization of these practices or of the physiologic limits that define GV. We sought to ascertain among Diaphragmatic Hernia Research and Exploration; Advancing Molecular Science (DHREAMS) centers’ GV practices in the neonatal management of CDH. Pediatric surgeons and neonatologists from DHREAMS centers completed an online survey on GV practices in infants with CDH. The survey gathered data on how individuals defined GV including ventilator settings, blood gas parameters and other factors of respiratory management. A total of 87 respondents, from 12 DHREAMS centers completed the survey for an individual response rate of 53% and a 92% center response rate. Approximately 99% of the respondents defined GV as accepting higher carbon dioxide (PCO2) and 60% of the respondents also defined GV as accepting a lower pH. There was less consensus about the use of sedation and neuromuscular blocking agents in GV, both within and across the centers. Acceptable pH and PCO2 levels are broader than the goal ranges. Despite a lack of formal standardization, the results suggest that GV practice is consistently defined as the use of permissive hypercapnia with mild respiratory acidosis and less consistently with the use of sedation and neuromuscular blocking agents. GV is the reported practice of surveyed neonatologists and pediatric surgeons in the respiratory management of infants with CDH.

Keywords: Clinician survey; congenital diaphragmatic hernia; ventilation

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About the article

Corresponding author: Christiana Farkouh-Karoleski, MD, MPH, New York Presbyterian Columbia University, Division of Neonatology, 3959 Broadway, BHN 12-20B, NY 10032, USA, Tel.: +212 305 6350, Fax: +212 342 5232


Received: 2016-08-12

Accepted: 2016-12-28

Published Online: 2017-01-28

Published in Print: 2017-12-20


Author’s statement

Conflict of interest: Authors state no conflict of interest.

Material and methods: Informed consent: Informed consent has been obtained from all individuals included in this study.

Funding source: This work was supported by NIH grant HD057036.

Financial Disclosure: The authors have no financial relationships relevant to this article to disclose.

Clinical Trials: NCT00950118.

Clinical Trial Registration: NCT00950118.

Contributors’ statements: Drs. Needelman, Farkouh-Karoleski, Aspelund and Najaf conceptualized and designed the study, coordinated and supervised data collection, analyzed data, drafted the initial manuscript and approved the final manuscript as submitted. Ms. Wynn coordinated and supervised data collection, analyzed data, drafted the initial manuscript and approved the final manuscript submitted. Dr. Chung provided funding, drafted the initial manuscript and approved the final manuscript submitted. Drs. Stolar, Mychaliska, Warner, Wagner, Cusick, Lim, Schindel, Potoka, Azarow, Cotten, Hesketh, Soffer, Crombleholme, coordinated and supervised data collection, critically reviewed the manuscript and approved the final manuscript as submitted.


Citation Information: Journal of Perinatal Medicine, Volume 45, Issue 9, Pages 1031–1038, ISSN (Online) 1619-3997, ISSN (Print) 0300-5577, DOI: https://doi.org/10.1515/jpm-2016-0271.

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