Congenital diaphragmatic hernia management: A systematic review and care pathway description including volume-targeted ventilation

Karen V. Duncan, Stephanie Polites, Sanjay Krishnaswami, Brian Scottoline

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Although it is well established that standardized treatment protocols improve outcomes for infants with congenital diaphragmatic hernia (CDH), there remains variance between existing protocols. Purpose: The purpose of this article was to review current literature on protocols for CDH management in the preoperative period and to describe a care pathway integrating best practice elements from existing literature with volume-targeted ventilation strategies previously in place at a major tertiary care center in the Pacific Northwestern United States. Methods/Search Strategy: A systematic review of literature was performed according to PRISMA guidelines to identify current publications on CDH protocols and examine them for similarities and differences, particularly regarding ventilation strategies. Findings/Results: Although existing protocols from multiple regions worldwide shared common goals of reducing barotrauma and delaying surgery until a period of clinical stabilization was achieved, their strategies varied. None included volume-targeted ventilation with pressure limitation as a method of avoiding ventilation-induced lung injury (VILI). Implications for Practice: Institutions that routinely manage infants with CDH should have a standardized treatment protocol in place, as this is shown to improve outcomes. This may include volume-targeted ventilation with pressure limitation as a successful VILI-limiting strategy. Implications for Research: While standardized protocols have been shown to increase survival rate for infants with CDH, more research is needed to determine what these protocols should include. Specifically, there is a need for future study on the most appropriate ventilation mode for this population.

Original languageEnglish (US)
JournalAdvances in Neonatal Care
DOIs
StateAccepted/In press - 2021

Keywords

  • Care guideline
  • Care pathway
  • Clinical protocol
  • Congenital diaphragmatic hernia
  • Neonate
  • Pulmonary hypertension
  • Pulmonary hypoplasia
  • Treatment protocol
  • Ventilation-induced lung injury
  • Volume-targeted ventilation

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

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