TY - JOUR
T1 - Congenital diaphragmatic hernia management
T2 - A systematic review and care pathway description including volume- targeted ventilation
AU - Duncan, Karen V.
AU - Polites, Stephanie
AU - Krishnaswami, Sanjay
AU - Scottoline, Brian P.
N1 - Publisher Copyright:
© 2021 Lippincott Williams and Wilkins. All rights reserved.
PY - 2021/10
Y1 - 2021/10
N2 - 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.
AB - 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.
KW - Care guideline
KW - Care pathway
KW - Clinical protocol
KW - Congenital diaphragmatic hernia
KW - Neonate
KW - Pulmonary hypertension
KW - Pulmonary hypoplasia
KW - Treatment protocol
KW - Ventilation-induced lung injury
KW - Volume-targeted ventilation
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U2 - 10.1097/ANC.0000000000000863
DO - 10.1097/ANC.0000000000000863
M3 - Article
C2 - 33843783
AN - SCOPUS:85107895257
SN - 1536-0903
VL - 21
SP - E138-E143
JO - Advances in Neonatal Care
JF - Advances in Neonatal Care
IS - 5
ER -