Diaphragmatic hernia medical therapy: Difference between revisions
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==Overview== | ==Overview== | ||
==== | ==Medical treatment== | ||
===Antenatal glucocorticoids=== | |||
[[Glucocorticoids|Antenatal glucocorticoids]] improve the survival by increasing the secretion of [[surfactant]] and thus stimulating lung maturation and preventing severe pulmonary hypoplasia.<ref name="pmid24580764">{{cite journal |vauthors=Badillo A, Gingalewski C |title=Congenital diaphragmatic hernia: treatment and outcomes |journal=Semin. Perinatol. |volume=38 |issue=2 |pages=92–6 |year=2014 |pmid=24580764 |doi=10.1053/j.semperi.2013.11.005 |url=}}</ref> | |||
===Preoperative stabilization=== | |||
*Preoperative stabilization of the patient is important as performing the operation in an unstable infant is associated with higher [[morbidity]] and [[mortality]] rates. | |||
*Preoperative stabilization measures include:<ref name="pmid22229104">{{cite journal |vauthors=Kesieme EB, Kesieme CN |title=Congenital diaphragmatic hernia: review of current concept in surgical management |journal=ISRN Surg |volume=2011 |issue= |pages=974041 |year=2011 |pmid=22229104 |pmc=3251163 |doi=10.5402/2011/974041 |url=}}</ref> | |||
**[[Mechanical ventilation]]: The aim is to ensure proper oxygenation without causing any [[barotrauma]] to the lung. Peak inspiratory pressure should be always less than 30 cm H2O | |||
**[[Nasogastric tube|Nasogastric tube insertion]]: The aim is to decompress the [[bowel]] and to give more space for the lung | |||
**[[Blood pressure]] support: using [[vasopressors]] or isotonic fluid: The aim is to keep the [[Mean arterial pressure|mean blood pressure]] above 50 mmHg.<ref name="pmid22229104">{{cite journal |vauthors=Kesieme EB, Kesieme CN |title=Congenital diaphragmatic hernia: review of current concept in surgical management |journal=ISRN Surg |volume=2011 |issue= |pages=974041 |year=2011 |pmid=22229104 |pmc=3251163 |doi=10.5402/2011/974041 |url=}}</ref> | |||
**High-frequency oscillatory ventilation: It is useful in improving the oxygenation without increasing the pressure in the airways or the alveoli. | |||
**[[Extracorporeal membrane oxygenation]]: It is used as the last resort in patients resistant to all the conventional methods of ventilation. | |||
**[[Nitric oxide|Inhaled nitric oxide]]: The [[hypoxemia]] resulting from lung compression can cause hypoxemia that may result in pulmonary vasoconstriction and hypertension. | |||
==References== | ==References== | ||
{{Reflist|2}} | {{Reflist|2}} | ||
Revision as of 16:38, 22 December 2017
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Diaphragmatic hernia Main page |
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Diagnosis |
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Treatment |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Ahmed Younes M.B.B.CH [2]
Overview
Medical treatment
Antenatal glucocorticoids
Antenatal glucocorticoids improve the survival by increasing the secretion of surfactant and thus stimulating lung maturation and preventing severe pulmonary hypoplasia.[1]
Preoperative stabilization
- Preoperative stabilization of the patient is important as performing the operation in an unstable infant is associated with higher morbidity and mortality rates.
- Preoperative stabilization measures include:[2]
- Mechanical ventilation: The aim is to ensure proper oxygenation without causing any barotrauma to the lung. Peak inspiratory pressure should be always less than 30 cm H2O
- Nasogastric tube insertion: The aim is to decompress the bowel and to give more space for the lung
- Blood pressure support: using vasopressors or isotonic fluid: The aim is to keep the mean blood pressure above 50 mmHg.[2]
- High-frequency oscillatory ventilation: It is useful in improving the oxygenation without increasing the pressure in the airways or the alveoli.
- Extracorporeal membrane oxygenation: It is used as the last resort in patients resistant to all the conventional methods of ventilation.
- Inhaled nitric oxide: The hypoxemia resulting from lung compression can cause hypoxemia that may result in pulmonary vasoconstriction and hypertension.
References
- ↑ Badillo A, Gingalewski C (2014). "Congenital diaphragmatic hernia: treatment and outcomes". Semin. Perinatol. 38 (2): 92–6. doi:10.1053/j.semperi.2013.11.005. PMID 24580764.
- ↑ 2.0 2.1 Kesieme EB, Kesieme CN (2011). "Congenital diaphragmatic hernia: review of current concept in surgical management". ISRN Surg. 2011: 974041. doi:10.5402/2011/974041. PMC 3251163. PMID 22229104.