Application of hand control high frequency continuous positive airway pressure on the neonatal transport of severe congenital diaphragmatic hernia / 中国小儿急救医学

ABSTRACT

Objective To investigate the clinic application significance of hand control high frequency continuous positive airway pressure treatment with self-inflating bags(SIB) fitted with positive end expiratory pressure (PEEP) valves on the neonatal transport of severe neonatal congenital diaphragmatic hemia (CDH).Methods Clinical data of a total of 28 infants with severe CDH transported by the pre-hospital emergency care team of our department were analyzed.The 28 patients were divided into treatment group (n =16) and control group (n =12).Hand control high frequency continuous positive airway pressure of SIB and PEEP valve were administered in the treatment group,while only hand control SIB positive airway pressure were given in the control group during the transportation.The exacerbation,complication and blood gas indicators at different time before and after treatment in two groups were monitored and compared.Results In the treatment group,no case aggravated,no case complicated with gas leakage,pulmonary hemorrhage,persistent pulmonary hypertension,intracranial hemorrhage; 2 cases died for multiple organ failure before operation (12.5％),5 cases died after operation (31.3％).In the control group,8 cases aggravated (66.7％),cases complicated with gas leakage,pulmonary hemorrhage,persistent pulmonary hypertension,intracranial hemorrhage were 5 (41.7 ％),3 (25.0％),1 (8.3 ％),respectively; 4 cases died for multiple organ failure before operation (41.7％),5 cases died after operation (33.3％).The indexes of pH,PaO2,PaCO2 and PaO2/FiO2 at different time before and after treatment between the treatment group and the control group or in each separate group all showed statistical significance (P ＜ 0.05).Conclusion Early accurate diagnosis during transportation with hand control high frequency continuous positive airway pressure of SIB fitted with PEEP valves for CDH is a safe and effective ventilation method which can reduce complications and increase successful transfer and survival rate.