Williams Emma, Greenough Anne
Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom.
Asthma UK Centre for Allergic Mechanisms in Asthma, King's College London, London, United Kingdom.
Front Pediatr. 2021 Dec 24;9:808317. doi: 10.3389/fped.2021.808317. eCollection 2021.
Optimisation of respiratory support of infants with congenital diaphragmatic hernia (CDH) is critical. Infants with CDH often have severe lung hypoplasia and abnormal development of their pulmonary vasculature, leading to ventilation perfusion mismatch. It is vital that lung protective ventilation strategies are employed during both initial stabilisation and post-surgical repair to avoid ventilator induced lung damage and oxygen toxicity to prevent further impairment to an already diminished gas-exchanging environment. There is a lack of robust evidence for the routine use of surfactant therapy during initial resuscitation of infants with CDH and thus administration cannot be recommended outside clinical trials. Additionally, inhaled nitric oxide has been shown to have no benefit in reducing the mortality rates of infants with CDH. Other therapeutic agents which beneficially act on pulmonary hypertension are currently being assessed in infants with CDH in randomised multicentre trials. The role of novel ventilatory modalities such as closed loop automated oxygen control, liquid ventilation and heliox therapy may offer promise for infants with CDH, but the benefits need to be determined in appropriately designed clinical trials.
优化先天性膈疝（CDH）婴儿的呼吸支持至关重要。患有CDH的婴儿通常有严重的肺发育不全和肺血管异常发育，导致通气灌注不匹配。在初始稳定期和手术后修复过程中采用肺保护性通气策略至关重要，以避免呼吸机诱发的肺损伤和氧中毒，防止对本已减少的气体交换环境造成进一步损害。在CDH婴儿的初始复苏过程中，缺乏关于常规使用表面活性剂治疗的有力证据，因此在临床试验之外不建议使用。此外，吸入一氧化氮已被证明对降低CDH婴儿的死亡率没有益处。目前正在对患有CDH的婴儿进行随机多中心试验，评估其他对肺动脉高压有有益作用的治疗药物。新型通气模式，如闭环自动氧控制、液体通气和氦氧混合气治疗的作用，可能为CDH婴儿带来希望，但需要在设计合理的临床试验中确定其益处。
