@article{ad93bded605c49b5901f9ee777d3ad8f,
title = "A definition of gentle ventilation in congenital diaphragmatic hernia: A survey of neonatologists and pediatric surgeons",
abstract = "Ventilation practices have changed significantly since the initial reports in the mid 1980 of successful use of permissive hypercapnia and spontaneous ventilation [often called gentle ventilation (GV)] in infants with congenital diaphragmatic hernia (CDH). However, there has been little standardization of these practices or of the physiologic limits that define GV. We sought to ascertain among Diaphragmatic Hernia Research and Exploration; Advancing Molecular Science (DHREAMS) centers' GV practices in the neonatal management of CDH. Pediatric surgeons and neonatologists from DHREAMS centers completed an online survey on GV practices in infants with CDH. The survey gathered data on how individuals defined GV including ventilator settings, blood gas parameters and other factors of respiratory management. A total of 87 respondents, from 12 DHREAMS centers completed the survey for an individual response rate of 53% and a 92% center response rate. Approximately 99% of the respondents defined GV as accepting higher carbon dioxide (PCO2) and 60% of the respondents also defined GV as accepting a lower pH. There was less consensus about the use of sedation and neuromuscular blocking agents in GV, both within and across the centers. Acceptable pH and PCO2 levels are broader than the goal ranges. Despite a lack of formal standardization, the results suggest that GV practice is consistently defined as the use of permissive hypercapnia with mild respiratory acidosis and less consistently with the use of sedation and neuromuscular blocking agents. GV is the reported practice of surveyed neonatologists and pediatric surgeons in the respiratory management of infants with CDH.",
keywords = "Clinician survey, Congenital diaphragmatic hernia, Ventilation",
author = "Christiana Farkouh-Karoleski and Tasnim Najaf and Julia Wynn and Gudrun Aspelund and Chung, {Wendy K.} and Stolar, {Charles J.} and Mychaliska, {George B.} and Warner, {Brad W.} and Wagner, {Amy J.} and Cusick, {Robert A.} and Lim, {Foong Yen} and Schindel, {David T.} and Douglas Potoka and Kenneth Azarow and Cotten, {C. Michael} and Anthony Hesketh and Samuel Soffer and Timothy Crombleholme and Howard Needelman",
note = "Funding Information: Acknowledgments: We greatly appreciate the clinicians who completed the survey and take care of CDH infants. A special appreciation for Dr. Jen Wung, who{\textquoteright}s lifetime work made this possible. This work was supported by National Institute of Health grant [HD057036] and was supported in part by Columbia University{\textquoteright}s Clinical and Translational Science Award (CTSA); grant [UL1 RR024156] from National Center for Advancing Translational Sciences/ National Institutes of Health (NCATS-NCRR/NIH) a grant from CHERUBS, a grant from the National Greek Orthodox Ladies Philoptochos Society, Inc. and generous donations from The Wheeler Foundation, Vanech Family Foundation, Larsen Family, Wilke Family and many other families. Funding Information: Ethical approval: The research related to human subject use has complied with all the relevant national regulations, and institutional policies, and is in accordance with the tenets of the Helsinki Declaration, and has been approved by the authors{\textquoteright} institutional review board or equivalent committee. Funding source: This work was supported by NIH grant HD057036. Financial Disclosure: The authors have no financial relationships relevant to this article to disclose. Clinical Trials: NCT00950118. Clinical Trial Registration: NCT00950118. Contributors{\textquoteright} statements: Drs. Needelman, Farkouh-Karoleski, Aspelund and Najaf conceptualized and designed the study, coordinated and supervised data collection, analyzed data, drafted the initial manuscript and approved the final manuscript as submitted. Ms. Wynn coordinated and supervised data collection, analyzed data, drafted the initial manuscript and approved the final manuscript submitted. Dr. Chung provided funding, drafted the initial manuscript and approved the final manuscript submitted. Drs. Stolar, Mychaliska, Warner, Wagner, Cusick, Lim, Schindel, Potoka, Azarow, Cotten, Hesketh, Soffer, Crombleholme, coordinated and supervised data collection, critically reviewed the manuscript and approved the final manuscript as submitted.",
year = "2017",
doi = "10.1515/jpm-2016-0271",
language = "English (US)",
volume = "45",
pages = "1031--1038",
journal = "Journal of Perinatal Medicine",
issn = "0300-5577",
publisher = "Walter de Gruyter GmbH & Co. KG",
number = "9",
}