Therapeutic algorithm in cases with congenital diaphragmatic hernia of the Bochdalek type.

UNLABELLED: The PURPOSE of the present study was to establish the treatment results of the applied approach for preoperative stabilization through mechanical ventilation and delayed surgical intervention as opposed to emergency surgical treatment in children with congenital diaphragmatic hernia.

PATIENTS AND

METHODS

Twenty-seven children have been treated (nine girls and 18 boys, twenty-four of them--newborns) over a ten-year period. The criteria for successful stabilization are arterial saturation of SaO2 90%, PaO2 = 90-100 mm Hg, PaCO2 40 mm Hg, pH 7.35.

RESULTS

Twenty-five of the children were with left-sided hernia (92.59%) and only two (7.41%) with right-sided hernia. The stabilization period ranged from 1 to 4 days, mean 1.48 +/- 0.18 (Sx = 0.81). Preoperatively, in eighteen newborns we used conventional mechanical ventilation; in one child only we used high frequency oscillating ventilation. In three children we failed to achieve stabilization and after worsening of their condition they died before they could be operated. In all children, postoperative mechanical ventilation was applied from 3 to 16 days, mean 7 +/- 0.65 (Sx = 3.16). The mortality was 59.26%.

CONCLUSIONS

The approach used for delayed surgical treatment has significant advantages compared to the urgent correction of the congenital diaphragmatic hernia. It provides opportunities for stabilization of the gas exchange and pulmonary circulation but still mortality remains high. New therapeutic techniques such as antenatal intervention or pulmonary transplantation are probably needed to save the lives of such patients.