High-Frequency Positive Pressure Ventilation as Primary Rescue Strategy for Patients with Congenital Diaphragmatic Hernia: A Comparison to High-Frequency Oscillatory Ventilation

Claire Gerall; Aaron Wallman-Stokes; Latoya Stewart; Jessica Price; Sandra Kabagambe; Weijia Fan; Rebecca Hernan; Jen Wung; Rakesh Sahni; Anna Penn; Vincent Duron

doi:10.1055/s-0041-1740076

American Journal of Perinatology, Table of Contents

Am J Perinatol 2024; 41(03): 255-262
DOI: 10.1055/s-0041-1740076

Original Article

High-Frequency Positive Pressure Ventilation as Primary Rescue Strategy for Patients with Congenital Diaphragmatic Hernia: A Comparison to High-Frequency Oscillatory Ventilation

Claire Gerall

¹Division of Pediatric Surgery, Department of Surgery, Columbia University Vagelos College of Physicians and Surgeons/NewYork-Presbyterian Morgan Stanley Children's Hospital, New York, New York

,

Aaron Wallman-Stokes

²Division of Neonatology, Department of Medicine, University of Vermont Medical Center/University of Vermont Medical Center Children's Hospital, Burlington, Vermont

,

Latoya Stewart

¹Division of Pediatric Surgery, Department of Surgery, Columbia University Vagelos College of Physicians and Surgeons/NewYork-Presbyterian Morgan Stanley Children's Hospital, New York, New York

,

Jessica Price

¹Division of Pediatric Surgery, Department of Surgery, Columbia University Vagelos College of Physicians and Surgeons/NewYork-Presbyterian Morgan Stanley Children's Hospital, New York, New York

,

Sandra Kabagambe

¹Division of Pediatric Surgery, Department of Surgery, Columbia University Vagelos College of Physicians and Surgeons/NewYork-Presbyterian Morgan Stanley Children's Hospital, New York, New York

,

Weijia Fan

³Department of Biostatistics, Columbia University Mailman School of Public Heath, New York, New York

,

Rebecca Hernan

¹Division of Pediatric Surgery, Department of Surgery, Columbia University Vagelos College of Physicians and Surgeons/NewYork-Presbyterian Morgan Stanley Children's Hospital, New York, New York

,

Jen Wung

⁴Division of Neonatology, Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons, New York, New York

,

Rakesh Sahni

⁴Division of Neonatology, Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons, New York, New York

,

Anna Penn

⁴Division of Neonatology, Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons, New York, New York

,

Vincent Duron

¹Division of Pediatric Surgery, Department of Surgery, Columbia University Vagelos College of Physicians and Surgeons/NewYork-Presbyterian Morgan Stanley Children's Hospital, New York, New York

› Author Affiliations

Abstract

Objective The aim of this article was to evaluate high-frequency positive pressure ventilation (HFPPV) compared with high-frequency oscillatory ventilation (HFOV) as a rescue ventilation strategy for patients with congenital diaphragmatic hernia (CDH). HFPPV is a pressure-controlled conventional ventilation method utilizing high respiratory rate and low positive end-expiratory pressure.

Study Design Seventy-seven patients diagnosed with CDH from January 2005 to September 2019 who were treated with stepwise progression from HFPPV to HFOV versus only HFOV were included. Fisher's exact test and the Kruskal–Wallis test were used to compare outcomes.

Results Patients treated with HFPPV + HFOV had higher survival to discharge (80 vs. 50%, p = 0.007) and to surgical intervention (95.6 vs. 68.8%, p = 0.003), with average age at repair 2 days earlier (p = 0.004). Need for extracorporeal membrane oxygenation (p = 0.490), inhaled nitric oxide (p = 0.585), supplemental oxygen (p = 0.341), and pulmonary hypertension medications (p = 0.381) were similar.

Conclusion In CDH patients who fail respiratory support with conventional ventilation, HFPPV may be used as an intermediary mode of rescue ventilation prior to HFOV without adverse effects.

Key Points

HFPPV may be used as an intermediary mode of rescue ventilation prior to HFOV without adverse effect.
HFPPV is more widely available and can mitigate the limitations faced when using HFOV.
HFPPV allows for intra- or interhospital transfer of neonates with CDH.

Keywords

congenital diaphragmatic hernia - high-frequency oscillatory ventilation - high-frequency positive pressure ventilation - mechanical ventilation - pulmonary hypertension - extracorporeal membrane oxygenation

Full Text

References

References
1 Puri P. Congenital diaphragmatic hernia and eventration. In: Puri P, Hollwarth M. eds. Pediatric Surgery. Berlin, Heidelberg: Springer; 2019: 95-100
2 Lally KP. Congenital diaphragmatic hernia. Curr Opin Pediatr 2002; 14 (04) 486-490
3 Harting MT, Lally KP. The congenital diaphragmatic hernia study group registry update. Semin Fetal Neonatal Med 2014; 19 (06) 370-375
4 Logan JW, Cotten CM, Goldberg RN, Clark RH. Mechanical ventilation strategies in the management of congenital diaphragmatic hernia. Semin Pediatr Surg 2007; 16 (02) 115-125
5 van den Hout L, Tibboel D, Vijfhuize S, te Beest H, Hop W, Reiss I. CDH-EURO Consortium. The VICI-trial: high frequency oscillation versus conventional mechanical ventilation in newborns with congenital diaphragmatic hernia: an international multicentre randomized controlled trial. BMC Pediatr 2011; 11: 98
6 Bhuta T, Clark RH, Henderson-Smart DJ. Rescue high frequency oscillatory ventilation vs conventional ventilation for infants with severe pulmonary dysfunction born at or near term. Cochrane Database Syst Rev 2001; (01) CD002974
7 Henderson-Smart DJ, Cools F, Bhuta T, Offringa M. Elective high frequency oscillatory ventilation versus conventional ventilation for acute pulmonary dysfunction in preterm infants. Cochrane Database Syst Rev 2007; (03) CD000104
8 deLemos R, Yoder B, McCurnin D, Kinsella J, Clark R, Null D. The use of high-frequency oscillatory ventilation (HFOV) and extracorporeal membrane oxygenation (ECMO) in the management of the term/near term infant with respiratory failure. Early Hum Dev 1992; 29 (1–3): 299-303
9 Sakurai Y, Azarow K, Cutz E, Messineo A, Pearl R, Bohn D. Pulmonary barotrauma in congenital diaphragmatic hernia: a clinicopathological correlation. J Pediatr Surg 1999; 34 (12) 1813-1817
10 Areechon W, Reid L. Hypoplasia of lung with congenital diaphragmatic hernia. BMJ 1963; 1 (5325): 230-233
11 Berdon WE, Baker DH, Amoury R. The role of pulmonary hypoplasia in the prognosis of newborn infants with diaphragmatic hernia and eventration. Am J Roentgenol Radium Ther Nucl Med 1968; 103 (02) 413-421
12 Kitagawa M, Hislop A, Boyden EA, Reid L. Lung hypoplasia in congenital diaphragmatic hernia. A quantitative study of airway, artery, and alveolar development. Br J Surg 1971; 58 (05) 342-346
13 Naeye RL, Shochat SJ, Whitman V, Maisels MJ. Unsuspected pulmonary vascular abnormalities associated with diaphragmatic hernia. Pediatrics 1976; 58 (06) 902-906
14 Levin DL. Morphologic analysis of the pulmonary vascular bed in congenital left-sided diaphragmatic hernia. J Pediatr 1978; 92 (05) 805-809
15 Geggel RL, Murphy JD, Langleben D, Crone RK, Vacanti JP, Reid LM. Congenital diaphragmatic hernia: arterial structural changes and persistent pulmonary hypertension after surgical repair. J Pediatr 1985; 107 (03) 457-464
16 Sakai H, Tamura M, Hosokawa Y, Bryan AC, Barker GA, Bohn DJ. Effect of surgical repair on respiratory mechanics in congenital diaphragmatic hernia. J Pediatr 1987; 111 (03) 432-438
17 Nakayama DK, Motoyama EK, Tagge EM. Effect of preoperative stabilization on respiratory system compliance and outcome in newborn infants with congenital diaphragmatic hernia. J Pediatr 1991; 118 (05) 793-799
18 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 (03) 406-409
19 Desfrere L, Jarreau PH, Dommergues M. et al. Impact of delayed repair and elective high-frequency oscillatory ventilation on survival of antenatally diagnosed congenital diaphragmatic hernia: first application of these strategies in the more “severe” subgroup of antenatally diagnosed newborns. Intensive Care Med 2000; 26 (07) 934-941
20 Ivascu FA, Hirschl RB. New approaches to managing congenital diaphragmatic hernia. Semin Perinatol 2004; 28 (03) 185-198
21 Miguet D, Claris O, Lapillonne A, Bakr A, Chappuis JP, Salle BL. Preoperative stabilization using high-frequency oscillatory ventilation in the management of congenital diaphragmatic hernia. Crit Care Med 1994; 22 (9, suppl): S77-S82
22 Migliazza L, Bellan C, Alberti D. et al. Retrospective study of 111 cases of congenital diaphragmatic hernia treated with early high-frequency oscillatory ventilation and presurgical stabilization. J Pediatr Surg 2007; 42 (09) 1526-1532
23 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 (02) 145-150
24 Somaschini M, Locatelli G, Salvoni L, Bellan C, Colombo A. Impact of new treatments for respiratory failure on outcome of infants with congenital diaphragmatic hernia. Eur J Pediatr 1999; 158 (10) 780-784
25 Cacciari A, Ruggeri G, Mordenti M. et al. High-frequency oscillatory ventilation versus conventional mechanical ventilation in congenital diaphragmatic hernia. Eur J Pediatr Surg 2001; 11 (01) 3-7
26 van den Hout L, Reiss I, Felix JF. et al; Congenital Diaphragmatic Hernia Study Group. Risk factors for chronic lung disease and mortality in newborns with congenital diaphragmatic hernia. Neonatology 2010; 98 (04) 370-380
27 Snoek KG, Capolupo I, van Rosmalen J. et al. Conventional mechanical ventilation versus high-frequency oscillatory ventilation for congenital diaphragmatic hernia: a randomized clinical trial (the VICI-trial). Ann Surg 2016; 263 (05) 867-874
28 Branson RD, Griebel J, Rodriquez Jr D. A bench study of inhaled nitric oxide delivery during high frequency percussive ventilation. Pediatr Pulmonol 2018; 53 (03) 337-341
29 Krishnan JA, Brower RG. High-frequency ventilation for acute lung injury and ARDS. Chest 2000; 118 (03) 795-807
30 Standiford TJ, Morganroth ML. High-frequency ventilation. Chest 1989; 96 (06) 1380-1389
31 Borg U, Eriksson I, Sjøstrand U. High-frequency positive-pressure ventilation (HFPPV): a review based upon its use during bronchoscopy and for laryngoscopy and microlaryngeal surgery under general anesthesia. Anesth Analg 1980; 59 (08) 594-603
32 Heijman K, Heijman L, Jonzon A, Sedin G, Sjöstrand U, Widman B. High frequency positive pressure ventilation during anaesthesia and routine surgery in man. Acta Anaesthesiol Scand 1972; 16 (03) 176-187
33 Beresford MW, Shaw NJ. Outcome of congenital diaphragmatic hernia. Pediatr Pulmonol 2000; 30 (03) 249-256
34 Akinkuotu AC, Cruz SM, Cass DL. et al. Revisiting outcomes of right congenital diaphragmatic hernia. J Surg Res 2015; 198 (02) 413-417
35 Sreenan C, Etches P, Osiovich H. The western Canadian experience with congenital diaphragmatic hernia: perinatal factors predictive of extracorporeal membrane oxygenation and death. Pediatr Surg Int 2001; 17 (2–3): 196-200
36 Alfaraj MA, Shah PS, Bohn D. et al. Congenital diaphragmatic hernia: lung-to-head ratio and lung volume for prediction of outcome. Am J Obstet Gynecol 2011; 205 (01) 43.e1-43.e8
37 Guibaud L, Filiatrault D, Garel L. et al. Fetal congenital diaphragmatic hernia: accuracy of sonography in the diagnosis and prediction of the outcome after birth. AJR Am J Roentgenol 1996; 166 (05) 1195-1202
38 Oluyomi-Obi T, Kuret V, Puligandla P. et al. Antenatal predictors of outcome in prenatally diagnosed congenital diaphragmatic hernia (CDH). J Pediatr Surg 2017; 52 (05) 881-888
39 Usui N, Okuyama H, Sawai T, Kamiyama M, Kamata S, Fukuzawa M. Relationship between L/T ratio and LHR in the prenatal assessment of pulmonary hypoplasia in congenital diaphragmatic hernia. Pediatr Surg Int 2007; 23 (10) 971-976
40 Straňák Z, Krofta L, Haak LA. et al. Antenatal assessment of liver position, rather than lung-to-head ratio (LHR) or observed/expected LHR, is predictive of outcome in fetuses with isolated left-sided congenital diaphragmatic hernia. J Matern Fetal Neonatal Med 2017; 30 (01) 74-78
41 Miller AG, Bartle RM, Rehder KJ. High-frequency jet ventilation in neonatal and pediatric subjects: a narrative review. Respir Care 2021; 66 (05) 845-856
42 Zhang Q, Macartney J, Sampaio L, O'Brien K. High frequency jet ventilation during initial management, stabilization, and transport of newborn infants with congenital diaphragmatic hernia: a case series. Crit Care Res Pract 2013; 2013: 937871