Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0019270 (hernia)
15,856 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Extracorporeal membrane oxygenation (ECMO) is an approved therapy for some neonates who have respiratory failure that is due to hyaline membrane disease, meconium aspiration, persistent pulmonary hypertension, congenital diaphragmatic hernia, or sepsis. The major complication of this therapy is hemorrhage, with intracranial hemorrhage having the highest morbidity and mortality. Seizures, incisional bleeding and bleeding in the pleural space, hypoxic-ischemic encephalopathy, renal failure, and cardiovascular complications account for most of the other complications. Cranial sonography provides an ideal imaging modality for baseline evaluation and daily follow-up; however, computed tomography and magnetic resonance imaging, because of better sensitivity, are important for assessment after ECMO. The changes in intracranial blood flow related to ECMO can be noninvasively evaluated by Doppler ultrasound modalities.
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PMID:Neurosonographic findings in infants treated by extracorporeal membrane oxygenation (ECMO). 268 79

Congenital diaphragmatic hernia (CDH) remains one of the major challenges for paediatric surgeons and paediatric intensive care specialists. Death in patients with CDH is 30-60% worldwide due to severe pulmonary hypoplasia or pulmonary hypoplasia associated with persistent pulmonary hypertension, secondary to hypoxia, metabolic acidosis or myocardial insufficiency. Pre-operative stabilisation of CDH patients might reduce the risks of these complications. In a two-year period 16 high-risk patients with CDH (respiratory insufficiency less than 6 hrs after birth) underwent delayed surgery following a stabilisation period (mean 14 hrs). Continuous suctioning on a nasogastric tube resulted in total resolution of the mediastinal shift on repeat x-rays. The use of the ventilation parameters arterial alveolar oxygen gradient (A-aDO2), oxygenation index (OI) and mean airway pressure (MAP) revealed three different groups of patients: I consisting of 6 survivors, II two preventable deaths and III eight non-survivors. In this way selection of patients with CDH is possible. In patients who do not improve during the stabilisation period alternative ways of treatment have to be evaluated such as extracorporeal membrane oxygenation (ECMO), high frequency oscillation (HFO) or high frequency jet ventilation (HFJV). Application of the ventilation parameters in prospective trials of patients with CDH enables comparison between different ways of treatment in the future.
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PMID:Pre-operative stabilisation with delayed repair in congenital diaphragmatic hernia. 275 Mar 38

Despite advances made in the care of infants with congenital diaphragmatic hernia (CDH), survival remains poor. New therapy, such as extracorporeal membrane oxygenation (ECMO), is controversial but may improve survival. Thirty-two newborns with CDH were treated. Thirteen infants were treated with jugular vein-carotid artery ECMO after CDH repair elsewhere; six (46%) survived. Three of the remaining 19 were moribund shortly after birth and first received ECMO, then underwent repair; two (67%) survived. The other 16 underwent CDH repair; 8 of 9 (89%) recovered with conventional therapy, and 4 of 7 (57%) survived when ECMO was used after conventional therapy failed. Overall survival was 63%. Parameters with which physicians may attempt to predict survival or the need for ECMO after repair--such as A-aDO2, ventilatory index versus PCO2, presence of a "honeymoon period" (PaO2 greater than 100 mm Hg after repair), or oxygenation index--were unreliable. ECMO can improve survival in infants with CDH, probably through reversal of pulmonary hypertension. Presently available methods of predicting survival after CDH repair with or without ECMO are not accurate, and thus no infant should be excluded from repair or ECMO support.
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PMID:A critical analysis of extracorporeal membrane oxygenation for congenital diaphragmatic hernia. 236 Jan 82

A 3,200 g birth weight, 38-week gestational age neonate developed very severe persistent pulmonary hypertension following surgical repair of a left diaphragmatic hernia. Despite administration of dopamine, dobutamine, and tolazoline, a significant alveolar-arterial oxygen difference (660 mmHg) was found at age 41 hours. Nifedipine was then administered sublingually in a dose of 1 mg/kg and produced an immediate and dramatic improvement in the right radial artery pO2 that was sustained despite persistence of the right-to-left shunt. We discuss the mode of action of this vasodilating agent that, when added to major therapeutic agents, proved capable of completely reversing a hazardous neonatal situation.
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PMID:[Efficacy of nifedipine on refractory hypoxemia associated with diaphragmatic hernia in the newborn infant. Apropos of a case]. 281 6

Extracorporeal membrane oxygenation (ECMO) provides lung rest for moribund infants with congenital diaphragmatic hernia (CDH) after deterioration from a "honeymoon" period. This suggests that unstable pulmonary hypertension determines demise more than pulmonary hypoplasia. We avoided treating overwhelming pulmonary hypoplasia by using ECMO only if the premoribund condition had been marked by evidence of adequate lung parenchyma as a best preductal PO2 greater than 100 torr and PCO2 less than 50 torr with maximal therapy. Twenty-six CDH infants with respiratory distress within 4 hours survived operation. Five were not ECMO candidates, with best PO2 33 +/- 9, PCO2 157 +/- 30 torr, and died. Seven honeymoon infants, with best PO2 325 +/- 80, PCO2 27 +/- 5, survived without ECMO. Fourteen additional infants had honeymoon 26 +/- 13 hours with PO2 256 +/- 48, PCO2 30 +/- 8 followed by a-AdO2 gradients 600 torr x 16 +/- 4.5 hours despite maximal therapy. All 14 were treated with ECMO for 48 to 210 hours. Arterial blood gas values at initiation were PO2 34 +/- 6, PCO2 59 +/- 19, and pH 7.22 +/- 0.2. Right-to-left shunting due to pulmonary hypertension was documented by oximetry and two-dimensional echo/Doppler examination. Twelve of 14 (86%) ECMO-treated infants survived with normal arterial blood gas values on room air, no right-to-left shunting, and no gross neurologic sequellae to date. Two of 14 died. Improvement on ECMO was marked by positive hyperoxia response and decreased right-to-left shunting.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Selective use of extracorporeal membrane oxygenation in the management of congenital diaphragmatic hernia. 312 55

The clinical use of extracorporeal membrane oxygenation (ECMO) in the treatment of persistent pulmonary hypertension following surgical repair of congenital diaphragmatic hernia is reported on 11 patients. The patients had a total of 13 treatments; two patients had two treatments. During the same period of clinical use, 122 patients were placed on ECMO for all causes. The indications, results, and complications of the use of ECMO for treatment following surgical repair of congenital diaphragmatic hernia are presented. The reversal of persistent pulmonary hypertension is demonstrated. All patients treated by ECMO for congenital diaphragmatic hernia have survived.
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PMID:Clinical use of extracorporeal membrane oxygenation in the treatment of persistent pulmonary hypertension following surgical repair of congenital diaphragmatic hernia. 323 58

Extracorporeal Membrane Oxygenation (ECMO) is a promising alternative for newborns with critical respiratory disease, where conservative management is no longer sufficient. - Indications for ECMO include mainly the diagnoses Persisting Pulmonary Hypertension (PPHN), Meconium-Aspiration and Congenital Diaphragmatic Hernia. In patients with a mortality-prognosis of 80-100% ECMO will raise survival rates to about 80% with a good general developmental prognosis. Conditions, trainee programs, and experiences up to the first clinical application of ECMO are reported.
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PMID:[Extracorporeal membrane oxygenation (ECMO). A treatment alternative for newborn infants with severe respiratory disorder]. 332 93

A prenatal diagnosis of congenital diaphragmatic hernia (CDH) is associated with a poor prognosis, especially if diagnosed early in gestation and associated with polyhydramnios. Although uncommon, it is important to rule out associated anomalies, so that elective termination can be considered. If CDH is an isolated anomaly, the outcome is related to the degree of pulmonary hypoplasia caused by viscera displacing the lung in utero. Unfortunately, our ability to assess lung size, and thus prognosis, is limited. Most babies with CDH either die shortly after birth or survive to lead normal lives, so that continuation of the pregnancy is extremely unlikely to produce a chronically ill pulmonary cripple. The fetus should be followed with periodic ultrasounds and delivered at a perinatal center with appropriate neonatal and surgical expertise. There is no evidence that altering the timing or mode of delivery affects outcome. The only way to alter outcome and save the severely affected fetus is to remove the viscera from the chest and allow the fetal lung to develop before birth. Despite the fact that fetal repair of CDH makes sense physiologically, however, it remains a highly experimental technique. Postnatal management of CDH involves resuscitation, paralysis, and positive pressure ventilation. The practice of emergency repair is not supported by pathophysiology, and operation should be delayed until the patient has been stabilized. Mortality is often due to pulmonary hypoplasia, but in some cases, there is a period of deterioration due to pulmonary hypertension resulting in right-to-left shunting (persistent fetal circulation). Pharmacological agents are often used to decrease pulmonary vascular resistance and increase cardiac output.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Congenital diaphragmatic hernia: current controversies in prenatal and postnatal management. 350 95

A left diaphragmatic hernia was created surgically in 20 fetal lambs between 93 and 110 days of gestation. Ten animals were alive with defects at cesarean section near term (135 to 140 days). These animals and two controls were submitted to various transpulmonary pressure gradients (inspiratory pressure minus pleural pressure). Hemodynamic and ventilatory studies were performed after the correction of the hernia. Morphometric analysis of the lung was carried out in all cases. The results showed a highly significant linear correlation between the transpulmonary pressure gradient employed and the pulmonary interstitial emphysema found at morphometry. Our data suggest that using low ventilatory pressures and not draining the pleural cavity results in less trauma to both lungs and may prevent one of the components of the pulmonary hypertension so often seen in newborns with congenital diaphragmatic hernia.
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PMID:Pulmonary barotrauma in congenital diaphragmatic hernia: experimental study in lambs. 357 87

We carried out a prospective study in 66 infants with congenital diaphragmatic hernia within the first 6 hours of life to determine whether outcome is related to the degree of underlying pulmonary hypoplasia, as predicted by preoperative PaCO2, when correlated with an index of ventilation (VI = mean airway pressure X respiratory rate) and confirmed by postmortem analysis of the lung. Those infants with PaCO2 greater than 40 mm Hg before surgery had a 77% mortality; when PaCO2 reduction could be achieved only with VI greater than 1000, the mortality was still greater than 50%. After repair, however, the ability to hyperventilate to PaCO2 less than 40 mm Hg proved to be an important determinant of survival; only one of 31 infants in this group died, whereas only two of 27 infants with PaCO2 greater than 40 mm Hg survived. In 16 infants with PaCO2 greater than 40 mm Hg despite hyperventilation, high-frequency oscillatory ventilation was started. This resulted in a rapid fall in PaCO2, but 14 of the 16 infants had only temporary improvement in oxygenation, and died. In five of the infants who died, alveolar number was assessed by postmortem morphometric analysis; there was a severe reduction to less than 10% of published normal neonatal values. Pulmonary vascular changes of increased muscularization were less remarkable than those observed in infants with persistent pulmonary hypertension. Our findings suggest that the degree of pulmonary hypoplasia (which would not be influenced by surgical repair), rather than the pulmonary vascular abnormality, mainly determines survival. Consideration could therefore be given to an initial nonsurgical approach to congenital diaphragmatic hernia, with the expectation that pulmonary function might improve and pulmonary vascular resistance decrease.
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PMID:Ventilatory predictors of pulmonary hypoplasia in congenital diaphragmatic hernia, confirmed by morphologic assessment. 362 14


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