Document Detail

Improved pulmonary function after surgical reduction of congenital diaphragmatic hernia in lambs.
MedLine Citation:
PMID:  10211647     Owner:  NLM     Status:  MEDLINE    
BACKGROUND/PURPOSE: Modern trends are toward delayed surgical reduction of congenital diaphragmatic hernia. This study was conducted to verify the hypothesis that the "ease" of ventilation found in the authors' postoperative experience in infants with congenital diaphragmatic hernia (CDH) is associated with postsurgical improvement in pulmonary mechanics. METHODS: Very severe CDH was surgically induced in utero at 90 days' gestation in 31 lambs. At birth pulmonary mechanics (PeDS-Lab) was measured in these preterm lambs with (n = 24) and without (n = 7) early surgical reduction, and in eight non-CDH controls over the same period; functional residual capacity (FRC) also was obtained from 14 of the 31 CDH lambs (seven reduced animals and seven unreduced ones). Management excluded aspiration from the thorax and insertion of chest drains. RESULTS: After 30 minutes of life CDH animals with early surgical reduction demonstrated significantly greater improvement in lung volume, pulmonary mechanics, and oxygenation than those without reduction: FRC, 235% versus 19%; compliance, 57% versus 14%; minute ventilation, 71% versus 30%; and PO2, 143% versus -15%. Over the same period, in preterm controls without CDH, only the compliance varied significantly, demonstrating a 32% increase. CONCLUSION: Based on the mechanics of breathing in these lambs, the authors speculate that neonates with CDH could benefit from early surgical repair because of improvement in pulmonary function, provided extra care is taken to prevent pulmonary overdistension.
D Major; R Cloutier; L Fournier; T H Shaffer; M R Wolfson
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Journal of pediatric surgery     Volume:  34     ISSN:  0022-3468     ISO Abbreviation:  J. Pediatr. Surg.     Publication Date:  1999 Mar 
Date Detail:
Created Date:  1999-05-28     Completed Date:  1999-05-28     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  0052631     Medline TA:  J Pediatr Surg     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  426-9     Citation Subset:  IM    
Laboratory of Investigation in Anesthesiology and Neonatology, Laval University Hospital Center (CHUQ), Québec, Canada.
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MeSH Terms
Animals, Newborn
Hernia, Diaphragmatic / congenital*,  physiopathology,  surgery*
Infant, Newborn
Lung / physiopathology*
Pulmonary Gas Exchange / physiology
Respiratory Function Tests
Respiratory Mechanics / physiology*
Time Factors

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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