Prediction of Length of Postoperative Ventilation in CDH Survivors; Preoperative and Operative Variables

Abstract

Background/Purpose: The period taken for complete weaning from ventilation in cases of repaired congenital diaphragmatic hernia (CDH) varies greatly. We tried to relate the endo-tracheal tube removal time (ETTRT) in these cases with the different variables; both preoperative and operative. Materials & Methods: This is a retrospective study of cases of CDH survivors managed by the authors over the period from January 2003 till February 2010. The preoperative variables included gestational age, gender, birth weight, Apgar score, the time of intubation, the ventilation strategy, the presence of a significant PDA in the ECHO study and the time-lapse till surgery. The operative variables (all by laparotomy approach) included the side of the hernia, the herniated contents, the presence of a sac, the insertion of a chest tube and the degree of abdominal wall stretch required. The successful weaning from ventilation and ETTRT were classified into two groups; ≤7 days and > 7 days postoperatively. Results: During the study period, 26 cases were included (21 Males and 5 females). The ETTRT ranged from 2 to 23 days (mean=7.7 ±7.15). Among the variables studied; the statistically significant ones (P value < 0.05) were Apgar score at 1 minute (preoperatively) and the need for "vigorous" abdominal wall stretch (operatively). Conclusion: Apgar score of less than 8 at 1 minute; preoperatively, and the need for "vigorous" abdominal wall stretch; operatively, were associated with delayed weaning from ventilation in CDH survivors. This could have a predictive value in the management of these cases.

Index Word: Congenital diaphragmatic hernia, Mechanical ventilation weaning, Endo-tracheal tube removal.