Abstract
Although the respiratory management with high frequency oscillatory ventilation (HFOV) has been generally performed for neonates with congenital diaphragmatic hernia (CDH) in Japan, the entry criteria for extracorporeal membrane oxygenation (ECMO) based on the data from the patients underwent HFOV has not been reported. To establish the entry criteria for ECMO in CDH patients treated with HFOV, the oxygenation index (OI) and the alveolar-arterial oxygen gradient (A-aDO_2) were retrospectively studied from 20 neonates with CDH treated with HFOV in our institutions from 1987 through 1993. OI and A-aDO_2 values were based on preductal and postductal arterial gas data drown from the admission to following 72 hours and detail ventilatory conditions. Patients were divided into two groups: candidates for ECMO. who underwent ECMO and died without ECMO. and non-candidates, who survived without ECMO. An preductal and postductal OI(mean value for 4 hours)>30, a postductal A-aDO_2≧620 torr for 4 hours and a postductal A-aD0_2≧580 torr for 8 hours showed a better sensitivity along with a specificity of 100% than the previous entry criteria that have been used in our institutions; a postductal OI>40, a postductal A-aDO_2≧610 torr for 8 hours and a postductal A-aDO_2≧600 torr for 12 hours. In addition, a combination of a preductal and postductal OI>30 indicated a sensitivity and a specificity of 100%.
