Work of breathing at different tidal volume targets in newborn infants with congenital diaphragmatic hernia

Rebecca Lee; Katie A. Hunt; Emma E. Williams; Theodore Dassios; Anne Greenough

doi:10.1007/s00431-022-04413-y

Work of breathing at different tidal volume targets in newborn infants with congenital diaphragmatic hernia

Rebecca Lee, Katie A. Hunt, Emma E. Williams, Theodore Dassios, Anne Greenough

Women & Children's Health

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Abstract

Congenital diaphragmatic hernia (CDH) results in varying degrees of pulmonary hypoplasia. Volume targeted ventilation (VTV) is a lung protective strategy but the optimal target tidal volume in CDH infants has not previously been studied. The aim of this study was to test the hypothesis that low targeted volumes would be better in CDH infants as determined by measuring the work of breathing (WOB) in CDH infants, at three different targeted tidal volumes. A randomised cross-over study was undertaken. Infants were eligible for inclusion in the study after surgical repair of their diaphragmatic defect. Targeted tidal volumes of 4, 5, and 6 ml/kg were each delivered in random order for 20-min periods with 20-min periods of baseline ventilation between. WOB was assessed and measured by using the pressure–time product of the diaphragm (PTPdi). Nine infants with a median gestational age at birth of 38 + 4 (range 36 + 4–40 + 6) weeks and median birth weight 3202 (range 2855–3800) g were studied. The PTPdi was higher at 4 ml/kg than at both 5, p = 0.008, and 6 ml/kg, p = 0.012. Conclusion: VTV of 4 ml/kg demonstrated an increased PTPdi compared to other VTV levels studied and should be avoided in post-surgical CDH infants.What is Known:• Lung injury secondary to mechanical ventilation increases the mortality and morbidity of infants with CDH.• Volume targeted ventilation (VTV) reduces ‘volutrauma’ and ventilator-induced lung injury in other neonatal intensive care populations.What is New:• A randomised cross-over trial was carried out investigating the response to different VTV levels in infants with CDH.• Despite pulmonary hypoplasia being a common finding in CDH, a VTV of 5ml/kg significantly reduced the work of breathing in infants with CDH compared to a lower VTV level.

Original language	English
Journal	European Journal of Pediatrics
DOIs	https://doi.org/10.1007/s00431-022-04413-y
Publication status	Published - 18 Mar 2022

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@article{a7758aa0d40446ebbef73a93e9e54220,

title = "Work of breathing at different tidal volume targets in newborn infants with congenital diaphragmatic hernia",

abstract = "Congenital diaphragmatic hernia (CDH) results in varying degrees of pulmonary hypoplasia. Volume targeted ventilation (VTV) is a lung protective strategy but the optimal target tidal volume in CDH infants has not previously been studied. The aim of this study was to test the hypothesis that low targeted volumes would be better in CDH infants as determined by measuring the work of breathing (WOB) in CDH infants, at three different targeted tidal volumes. A randomised cross-over study was undertaken. Infants were eligible for inclusion in the study after surgical repair of their diaphragmatic defect. Targeted tidal volumes of 4, 5, and 6 ml/kg were each delivered in random order for 20-min periods with 20-min periods of baseline ventilation between. WOB was assessed and measured by using the pressure–time product of the diaphragm (PTPdi). Nine infants with a median gestational age at birth of 38 + 4 (range 36 + 4–40 + 6) weeks and median birth weight 3202 (range 2855–3800) g were studied. The PTPdi was higher at 4 ml/kg than at both 5, p = 0.008, and 6 ml/kg, p = 0.012. Conclusion: VTV of 4 ml/kg demonstrated an increased PTPdi compared to other VTV levels studied and should be avoided in post-surgical CDH infants.What is Known:• Lung injury secondary to mechanical ventilation increases the mortality and morbidity of infants with CDH.• Volume targeted ventilation (VTV) reduces {\textquoteleft}volutrauma{\textquoteright} and ventilator-induced lung injury in other neonatal intensive care populations.What is New:• A randomised cross-over trial was carried out investigating the response to different VTV levels in infants with CDH.• Despite pulmonary hypoplasia being a common finding in CDH, a VTV of 5ml/kg significantly reduced the work of breathing in infants with CDH compared to a lower VTV level.",

author = "Rebecca Lee and Hunt, {Katie A.} and Williams, {Emma E.} and Theodore Dassios and Anne Greenough",

note = "Funding Information: KAH and EEW were supported by the Charles Wolfson Charitable Trust and additionally by SLE. This research was supported by the National Institute for Health Research (NIHR) Biomedical Research Centre at Guy{\textquoteright}s and St Thomas{\textquoteright} NHS Foundation Trust and King{\textquoteright}s College London. Publisher Copyright: {\textcopyright} 2022, The Author(s).",

year = "2022",

month = mar,

day = "18",

doi = "10.1007/s00431-022-04413-y",

language = "English",

journal = "European Journal of Pediatrics",

issn = "0340-6199",

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T1 - Work of breathing at different tidal volume targets in newborn infants with congenital diaphragmatic hernia

AU - Lee, Rebecca

AU - Hunt, Katie A.

AU - Williams, Emma E.

AU - Dassios, Theodore

AU - Greenough, Anne

N1 - Funding Information: KAH and EEW were supported by the Charles Wolfson Charitable Trust and additionally by SLE. This research was supported by the National Institute for Health Research (NIHR) Biomedical Research Centre at Guy’s and St Thomas’ NHS Foundation Trust and King’s College London. Publisher Copyright: © 2022, The Author(s).

PY - 2022/3/18

Y1 - 2022/3/18

N2 - Congenital diaphragmatic hernia (CDH) results in varying degrees of pulmonary hypoplasia. Volume targeted ventilation (VTV) is a lung protective strategy but the optimal target tidal volume in CDH infants has not previously been studied. The aim of this study was to test the hypothesis that low targeted volumes would be better in CDH infants as determined by measuring the work of breathing (WOB) in CDH infants, at three different targeted tidal volumes. A randomised cross-over study was undertaken. Infants were eligible for inclusion in the study after surgical repair of their diaphragmatic defect. Targeted tidal volumes of 4, 5, and 6 ml/kg were each delivered in random order for 20-min periods with 20-min periods of baseline ventilation between. WOB was assessed and measured by using the pressure–time product of the diaphragm (PTPdi). Nine infants with a median gestational age at birth of 38 + 4 (range 36 + 4–40 + 6) weeks and median birth weight 3202 (range 2855–3800) g were studied. The PTPdi was higher at 4 ml/kg than at both 5, p = 0.008, and 6 ml/kg, p = 0.012. Conclusion: VTV of 4 ml/kg demonstrated an increased PTPdi compared to other VTV levels studied and should be avoided in post-surgical CDH infants.What is Known:• Lung injury secondary to mechanical ventilation increases the mortality and morbidity of infants with CDH.• Volume targeted ventilation (VTV) reduces ‘volutrauma’ and ventilator-induced lung injury in other neonatal intensive care populations.What is New:• A randomised cross-over trial was carried out investigating the response to different VTV levels in infants with CDH.• Despite pulmonary hypoplasia being a common finding in CDH, a VTV of 5ml/kg significantly reduced the work of breathing in infants with CDH compared to a lower VTV level.

AB - Congenital diaphragmatic hernia (CDH) results in varying degrees of pulmonary hypoplasia. Volume targeted ventilation (VTV) is a lung protective strategy but the optimal target tidal volume in CDH infants has not previously been studied. The aim of this study was to test the hypothesis that low targeted volumes would be better in CDH infants as determined by measuring the work of breathing (WOB) in CDH infants, at three different targeted tidal volumes. A randomised cross-over study was undertaken. Infants were eligible for inclusion in the study after surgical repair of their diaphragmatic defect. Targeted tidal volumes of 4, 5, and 6 ml/kg were each delivered in random order for 20-min periods with 20-min periods of baseline ventilation between. WOB was assessed and measured by using the pressure–time product of the diaphragm (PTPdi). Nine infants with a median gestational age at birth of 38 + 4 (range 36 + 4–40 + 6) weeks and median birth weight 3202 (range 2855–3800) g were studied. The PTPdi was higher at 4 ml/kg than at both 5, p = 0.008, and 6 ml/kg, p = 0.012. Conclusion: VTV of 4 ml/kg demonstrated an increased PTPdi compared to other VTV levels studied and should be avoided in post-surgical CDH infants.What is Known:• Lung injury secondary to mechanical ventilation increases the mortality and morbidity of infants with CDH.• Volume targeted ventilation (VTV) reduces ‘volutrauma’ and ventilator-induced lung injury in other neonatal intensive care populations.What is New:• A randomised cross-over trial was carried out investigating the response to different VTV levels in infants with CDH.• Despite pulmonary hypoplasia being a common finding in CDH, a VTV of 5ml/kg significantly reduced the work of breathing in infants with CDH compared to a lower VTV level.

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U2 - 10.1007/s00431-022-04413-y

DO - 10.1007/s00431-022-04413-y

M3 - Article

SN - 0340-6199

JO - European Journal of Pediatrics

JF - European Journal of Pediatrics

ER -

Work of breathing at different tidal volume targets in newborn infants with congenital diaphragmatic hernia

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