Abstract
Introduction: In children with congenital diaphragmatic hernia (CDH) artificial ventilation with high pressures and high inspiratory oxygen fraction is often required. We studied the effect of artificial ventilation in CDH in an experimental rat model of CDH. Earlier studies revealed that after ventilation with peak inspiratory pressures (PIP) of 17 cm H2O no aeration of lungs was observed in controls and CDH, but the lungs could be aerated with PIP of 25 cm H2O. To evaluate optimal ventilatory strategy the clinical and histological aspects were studied using two different ventilatory settings.
Methods: CDH was induced by administration of Nitrofen (J Pediatr Surg 1990:25:850). The animals were delivered at term. Pressure-controlled artificial ventilation started immediately after birth for six hours. Group 1 was ventilated with PIP of 25 cm H2O, group 2 with of 25 cm H2O for 15 minutes followed by PIP of 17 cm H2O. Other settings for both groups were: PEEP 3 cm H2O, freq. 40/min and FiO2, 1. The lungs of surviving rats were fixed in formalin without standard inflation.
Conclusion: We conclude that high opening pressures are needed. The centroacinar lung expansion and the incidence of pneumothorax in CDH rats is similar to the situation seen in premature children with respiratory distress syndrome and primary or secondary surfactant deficiency.(Supported by the Netherlands Asthma Fund 91.56).
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Ijsselstijn, H., Scheffers, E., Van Mierf, M. et al. 282 HISTOLOGICAL FINDINGS IN ARTIFICIALLY VENTILATED NEONATAL RATS WITH CONGENITAL DIAPHRAGMATIC HERNIA. Pediatr Res 36, 49 (1994). https://doi.org/10.1203/00006450-199407000-00282
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DOI: https://doi.org/10.1203/00006450-199407000-00282
