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

Over the last ten years the survival of infants born with congenital diaphragmatic hernia who reach the Intensive Care Unit of the Royal Children's Hospital, Melbourne has been constant at 56 +/- 6%. Experimental therapies such as extracorporeal membrane oxygenation, high-frequency oscillation and lung transplantation are now being considered as therapeutic options, and as such the ability to predict survival or death of these infants is increasingly important. The records of all infants with congenital diaphragmatic hernia admitted to the Intensive Care Unit between 1 January 1980 and 30 April 1989 were reviewed; blood gas, ventilatory details, and outcome information was obtained. Receiver operating curve analysis was used to determine the best predictor of death. An oxygenation index (MAP x FiO2/PaO2) > 0.3 or ventilation index (PIP x RR x CO2/1000) > 70 predicted a 94% mortality with a specificity of 96% and a sensitivity of 82%.
 ...
PMID:Mortality prediction in infants with congenital diaphragmatic hernia: potential criteria for ECMO. 146 69

Over the past decade, the survival rate of infants with congenital diaphragmatic hernia (CDH) treated in the intensive care unit of the Royal Children's Hospital, Melbourne, has remained unchanged at 56% +/- 6%. Newer forms of treatment, such as extracorporeal membrane oxygenation (ECMO), high-frequency oscillation, and surfactant and nitric oxide therapy, are now available. The exact role of these therapies in the management of infants with CDH has not been determined. This study examines five clinical parameters derived from an infant's best preoperative ventilatory and blood gas data in the first 24 hours of life. One hundred twenty-five CDH infants were admitted to the intensive care unit between January 1, 1981 and December 31, 1991. Criteria for inclusion in the study were (1) CDH diagnosed within 6 hours of delivery, (2) ventilation before repair, and (3) no associated lethal congenital abnormality. Of the 90 cases studied in detail, there were 38 deaths (42% mortality rate). All five parameters were analyzed by receiver operating curve analysis to determine the optimum value of each parameter in predicting survival. An oxygenation index (MAP x FIO2/PaO2) of less than 0.08 predicted a 94% chance of survival, with a sensitivity of 96% and a specificity of 95%. Similarly, a modified ventilation index (PIP x RR x CO2/1,000) of less than 40 predicted a 91% chance of survival, with a sensitivity of 94% and a specificity of 86%. By stratifying each criterion according to outcome, three groups of infants were identified according to their response to conventional therapy.(ABSTRACT TRUNCATED AT 250 WORDS)
 ...
PMID:Predictors of survival for infants with congenital diaphragmatic hernia. 784 17

Surfactant therapy given before the onset of ventilation (surfactant prophylaxis) has been shown to improve oxygenation, ventilation, and pulmonary hemodynamics in the lamb model of congenital diaphragmatic hernia (CDH). The aim of this study was to assess the efficacy of surfactant administered after the onset of ventilation ("surfactant rescue"). Ten lambs with surgically created CDH were instrumented, at full term, to measure pulmonary blood flow and pulmonary vascular resistance (PVR). Catheters also were positioned for monitoring of systemic blood pressure and arterial blood gases. The animals were delivered and pressure-ventilated according to a standard protocol (PIP, 30 cm; PEEP, 4 cm; respiratory rate, 60 breaths per minute). After 30 minutes of ventilation, five animals received an intratracheal dose of calf lung surfactant extract (50 mg/kg). The animals were studied for 4 hours. Surfactant rescue had no discernible effect on Pco2, Pco2, or pH. There was an increase in pulmonary blood flow, but it was not significant. The dramatic improvement in oxygenation, ventilation, and pulmonary blood flow found with prophylactic surfactant cannot be reproduced when surfactant is administered as rescue therapy. This indicates that the surfactant is not being delivered adequately, the lungs have already incurred significant barotrauma, and/or the surfactant is being inactivated by alveolar protein. Therefore, the authors suggest that when exogenous surfactant therapy is being considered for the fetus or newborn with CDH, it should be administered as early as possible, preferably before the infant's first breath. Prenatal diagnosis and delivery in a tertiary care center would facilitate this optimum management.
 ...
PMID:Surfactant rescue in the fetal lamb model of congenital diaphragmatic hernia. 886 44