Diaphragmatic hernia medical therapy

Diaphragmatic hernia Main page
Patient Information
Overview
Historical Perspective
Classification
Pathophysiology
Differentiating Diaphragmatic hernia from other Diseases
Epidemiology
Risk factors
Screening
Natural History, Complications and Prognosis
Diagnosis
History and Symptoms
Physical Examination
Laboratory Findings
Radiological tests
Treatment
Medical treatment
Surgical treatment

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Ahmed Younes M.B.B.CH [2]

Overview

Antenatal glucocorticoids improve the survival by increasing surfactant secretion. Postnatal medical management is focused on stabilizing the infant before surgical intervention.

Medical treatment

Antenatal glucocorticoids

Antenatal glucocorticoids improve the survival by increasing the secretion of surfactant and thus stimulating lung maturation and preventing severe pulmonary hypoplasia.

Preoperative stabilization

• Preoperative stabilization of the patient is important as performing the operation in an unstable infant is associated with higher morbidity and mortality rates.
• Preoperative stabilization measures include:
  • Mechanical ventilation: The aim is to ensure proper oxygenation without causing any barotrauma to the lung. Peak inspiratory pressure should be always less than 30 cm H2O
  • Nasogastric tube insertion: The aim is to decompress the bowel and to give more space for the lung
  • Blood pressure support: using vasopressors or isotonic fluid: The aim is to keep the mean blood pressure above 50 mmHg.
  • High-frequency oscillatory ventilation: It is useful in improving the oxygenation without increasing the pressure in the airways or the alveoli.
  • Extracorporeal membrane oxygenation: It is used as the last resort in patients resistant to all the conventional methods of ventilation.
  • Inhaled nitric oxide: The hypoxemia resulting from lung compression can cause hypoxemia that may result in pulmonary vasoconstriction and hypertension.