Infant with Congenital Diaphragmatic Hernia Clinical Pathway, Pre and Post-operative Care — Inpatient and ICU

Universal Care for Infants with CDH Before Surgical Repair: Mechanical Ventilation

Goals

Maintain adequate gas exchange with lowest pressures and tidal volumes
Stable respiratory settings without need for ventilator adjustments in 24-48 hrs prior to repair, FiO₂ < 50%
To titrate ventilator settings, use goal pre-ductal oxygen saturation > 85% and FiO₂ rather than PaO₂

CDH Characteristic	Initial Ventilatory Strategy	Initial Targets
Liver Down Mild Right	Synchronized Intermittent Mandatory Ventilation Pressure Control (SIMV-PC)	PIP	≤ 25 cm H₂0
		PEEP	≤ 5 cm H₂0 Consider: Lower PEEP depending on lung inflation Higher PEEP transiently for significant atelectasis
		TV	4-6 ml/kg
Liver Up Severe Right Persistent hypercarbia despite maximal CMV settings	High Frequency Oscillatory Ventilation (HFOV)	MAP	11-13 based on chest X-ray inflation, expansion Obtain chest X-ray 1-2 hrs after MAP changes
		Hz	6-8
		Amp	Adjust amplitude based on wiggle

If you have questions about any of the clinical pathways or about the process of creating a clinical pathway, please contact us.

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The clinical pathways are based upon publicly available medical evidence and/or a consensus of medical practitioners at The Children’s Hospital of Philadelphia (“CHOP”) and are current at the time of publication. These clinical pathways are intended to be a guide for practitioners and may need to be adapted for each specific patient based on the practitioner’s professional judgment, consideration of any unique circumstances, the needs of each patient and their family, and/or the availability of various resources at the health care institution where the patient is located.

Accordingly, these clinical pathways are not intended to constitute medical advice or treatment, or to create a doctor-patient relationship between/among The Children’s Hospital of Philadelphia (“CHOP”), its physicians and the individual patients in question. CHOP does not represent or warrant that the clinical pathways are in every respect accurate or complete, or that one or more of them apply to a particular patient or medical condition. CHOP is not responsible for any errors or omissions in the clinical pathways, or for any outcomes a patient might experience where a clinician consulted one or more such pathways in connection with providing care for that patient.

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Infant with Congenital Diaphragmatic Hernia Clinical Pathway, Pre and Post-operative Care — Inpatient and ICU

Universal Care for Infants with CDH Before Surgical Repair: Mechanical Ventilation

Goals

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Innovation and your child

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Infant with Congenital Diaphragmatic Hernia, Pre and Post-operative Care — Universal Care Before Surgical Repair — Clinical Pathway: Inpatient and ICU

Infant with Congenital Diaphragmatic Hernia Clinical Pathway, Pre and Post-operative Care — Inpatient and ICU

Universal Care for Infants with CDH Before Surgical Repair: Mechanical Ventilation

Goals