Neurally adjusted ventilatory assist mode used in congenital diaphragmatic hernia

A term baby with congenital diaphragmatic hernia (CDH) underwent surgical repair on the second day of life. Postoperatively; the oxygenation index increased to 85 despite high pressure ventilation with HFOV (high frequency oscillator ventilation) and inhaled nitric oxide therapy. Oxygenation index a...

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Published inJournal of the College of Physicians and Surgeons--Pakistan Vol. 21; no. 10; pp. 637 - 639
Main Authors Durrani, Naveed-ur-Rehman, Chedid, Fares, Rahmani, Aiman
Format Journal Article
LanguageEnglish
Published Pakistan 01.10.2011
Subjects
Critical Illness - therapy
Hernia, Diaphragmatic - surgery
Hernia, Diaphragmatic - therapy
Hernias, Diaphragmatic, Congenital
High-Frequency Ventilation
Humans
Infant, Newborn
Interactive Ventilatory Support - methods
Oxygen - blood
Ventilator Weaning
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Summary:A term baby with congenital diaphragmatic hernia (CDH) underwent surgical repair on the second day of life. Postoperatively; the oxygenation index increased to 85 despite high pressure ventilation with HFOV (high frequency oscillator ventilation) and inhaled nitric oxide therapy. Oxygenation index above 70 carries a mortality rate of 94% and merits starting extracorporeal membrane oxygenation (not available in the UAE). A trial of neurally adjusted ventilatory assist (NAVA) on the 10th postoperative day was followed by a reduction of oxygenation index to 15 and marked improvement of the clinical parameters. The EAdi (electrical activity of diaphragm) signal was relatively weak (± 5 μvolt) requiring augmentation with a high NAVA level (3 - 3.5). The patient was successfully extubated after 3 weeks.
Bibliography:ObjectType-Case Study-2
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ISSN:1681-7168
DOI:10.2011/JCPSP.637639