Divisions of Neonatology (Ms Duncan and Dr Scottoline) and Pediatric Surgery (Drs Polites and Krishnaswami), Oregon Health and Science University, Portland.
Adv Neonatal Care. 2021 Oct 1;21(5):E138-E143. doi: 10.1097/ANC.0000000000000863.
Although it is well established that standardized treatment protocols improve outcomes for infants with congenital diaphragmatic hernia (CDH), there remains variance between existing protocols.
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).
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.
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.
虽然标准化治疗方案已被证实可改善先天性膈疝（CDH）患儿的预后，但目前仍存在各方案间的差异。
本文旨在回顾 CDH 术前管理方案的现有文献，并描述一条护理路径，该路径整合了来自现有文献的最佳实践要素以及美国太平洋西北地区一家主要三级医疗中心先前采用的容量目标性通气策略。
方法/搜索策略：根据 PRISMA 指南进行系统文献回顾，以确定关于 CDH 方案的现有出版物，并检查它们在通气策略方面的异同。
结果/发现：尽管来自全球多个地区的现有方案都有减少气压伤和延迟手术至临床稳定期的共同目标，但它们的策略存在差异。没有一个方案包括容量目标性通气和压力限制作为避免通气相关性肺损伤（VILI）的方法。
常规管理 CDH 婴儿的机构应制定标准化的治疗方案，因为这已被证明可改善预后。这可能包括容量目标性通气和压力限制作为成功的 VILI 限制策略。
虽然标准化方案已被证实可提高 CDH 婴儿的存活率，但仍需要更多的研究来确定这些方案应包括哪些内容。具体来说，需要进一步研究该人群最合适的通气模式。
