Continuous intrapulmonary distension with perfluorocarbon accelerates lung growth in infants with congenital diaphragmatic hernia: initial experience

J Pediatr Surg. 2001 Aug;36(8):1237-40. doi: 10.1053/jpsu.2001.25783.

Abstract

Background/purpose: The authors have shown previously in an animal model that neonatal lung growth can be accelerated by continuous intrapulmonary distension with a perfluorocarbon (PFC). The authors now describe a preliminary clinical experience with this therapeutic concept in a select group of infants with congenital diaphragmatic hernia (CDH).

Methods: Neonates with very high predicted mortality rate caused by CDH had their lungs completely filled with PFC while on extracorporeal life support (ECLS); (n = 5). A continuous positive pressure of 7 to 10 cm H2O was maintained via the endotracheal tube for 3 to 7 days (mean, 5.6 +/- 0.87 days). The areas of both lungs (L) then were measured daily from digitized chest x-rays and divided by the area of the corresponding L1 vertebrae (V), to create an L/V index, so as to control for variable roentgenographic techniques. Immediately after removal of PFC, blood gas data were collected off ECLS.

Results: At the end of continuous pulmonary distension, all patients showed improvements in oxygenation and ventilation. The ipsilateral lungs showed significant increase of the L/V index with time (P =.003) and of L/V's daily change (P <.0001), suggesting accelerated lung growth. Overall survival rate was 40% (2 of 5). Of the 3 patients that had 7 days of distension, 2 survived.

Conclusions: Continuous intrapulmonary distension with PFC for up to 1 week accelerated ipsilateral lung growth, improved gas exchange, and increased survival of CDH infants with profound pulmonary hypoplasia marooned on ECLS. Additional trials of PFC-based pulmonary distension in similar infants are warranted.

Publication types

  • Clinical Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Female
  • Fluorocarbons / administration & dosage*
  • Hernia, Diaphragmatic / mortality
  • Hernia, Diaphragmatic / therapy*
  • Hernias, Diaphragmatic, Congenital*
  • Humans
  • Infant
  • Infant, Newborn
  • Lung / growth & development*
  • Lung Volume Measurements
  • Male
  • Positive-Pressure Respiration / methods
  • Postoperative Care
  • Prognosis
  • Prospective Studies
  • Respiratory Function Tests
  • Respiratory Mechanics / physiology*
  • Sensitivity and Specificity
  • Survival Rate
  • Treatment Outcome

Substances

  • Fluorocarbons