2012 OPEN FORUM Abstracts
DURATION OF MECHANICAL VENTILATION AND DEADSPACE FRACTION IN INFANTS WITH CONGENITAL DIAPHRAGMATIC HERNIA FOLLOWING ECMO.
Erin Libbey1, Craig D. Smallwood1, Nancy Craig1, Jay Wilson2,3; 1Department of Respiratory Care, Boston Childrens Hospital, Boston, MA; 2Department of Surgery, Boston Childrens Hospital, Boston, MA; 3Harvard Medical School, Boston, MA
BACKGROUD: Children with congenital diaphragmatic hernia (CDH) are known to have complicated hospital stays and often experience prolonged mechanical ventilation and sometimes require the use of extracorporeal membrane oxygenation (ECMO). The purpose of this investigation was to determine the relationship between physiologic deadspace fraction (Vd/Vt) and duration of mechanical ventilation in children with CDH who required ECMO support. Additionally, we wanted to determine the ventilatory support 30 days after discontinuation of ECMO. METHODS: A retrospective database review was performed on patients with CDH requiring ECMO support. Patient weight, sex, age, Vd/Vt immediately after discontinuation of ECMO support, mechanical ventilator days post ECMO and respiratory support 30 days after separation from ECMO were recorded. Data was collected using MS Excel (v11.8342.8333, Microsoft, Redmond, WA). Statistical analysis was completed using Prism (v 5.01, GraphPad Software Incorporated, La Jolla, CA). Mean and standard deviation (SD) were used to describe patient demographics. Spearman correlation was used to determine the relationship between Vd/Vt and duration of mechanical ventilation after discontinuation of ECMO. RESULTS: Fourteen patients (10 males) were included in the analysis. Age (mean±SD) at cannulation was 1.4 ± 1.6 days, weight was 3.1 ± 0.6 kg. The mean duration of ventilation post ECMO was 44.75 days. Correlation between Vd/Vt and duration of ventilation was statistically significant (R=0.62, P=0.0302). At post ECMO day 30, 9 patients remained on conventional ventilatory support, 3 patients on nasal cannula, and 2 on CPAP via face or nasal mask. CONCLUSIONS: A statistically significant relationship was observed between Vd/Vt and duration of mechanical ventilation after ECMO. Duration of ventilation may be associated with increased length of ICU stay and morbidity. Measurement of Vd/Vt may help clinicians determine long term care needs of children with CDH. Because these findings were not evaluated prospectively, further research is in order. Sponsored Research - None