Diaphragatic Hernia

Question 1

What is Diaphragmatic Hernia?

Answer 1

Diaphragm formation interrupted by early migration of intestines or hypoplasia of membranes

• organs migrated into thoracic cavity = compression of structures during in utero development

Question 2

clinical manifestations of CDH

Answer 2

Barrel shaped chest + Schaphoid abdomen with Resp distress at birth w/high PVR.

• Severe acidosis/hypoxia bc of decreased surface area for gas exchange + pulmonary hypertension causing persistent fetal circulation
• displaced heart sounds and diminished/absent breath sounds on the affected side

Question 3

CDH management

Answer 3

Prompt intubation, BVM must be avoided

• OG/NG tube insertion with low suction = decrease distension of intensines bc of air
• surgery

Question 4

Why is bagging avoided in CDH?

Answer 4

Air entry into intestines = increased pressure inside intestines = pressure on lungs/heart

Question 5

What are ventilation strategies for CDH?

Answer 5

• Low volume, low PIP (<30cmH2O)
• Higher RR, increased peep…?
• HFO/HJV may be considered for lower PIP, higher MAP, adequate oxygenation/ventilation
• hyperoxygenate
• iNO = decreases pulmonary vasoconstriction = decreased PVR