Congenital Diaphragmatic Hernia and Eventration

Conclusion

After transfer to the intensive care unit, the infant is kept warm, given maintenance requirements of intravenous fluids and has vital signs monitored closely with regular blood gas analyses and monitoring of preductal and postductal oxygenation. Ventilatory support is continued postoperatively with the aim of maintaining preductal PO₂ around 80–100 mmHg, PCO₂ up to 60 mmHg, and pH greater than 7.25 with hyperventilation (rates up to 150 per min) and the lowest possible pressures and low tidal volumes. The intrathoracic air pocket will usually reabsorb but evidence of increasing air and fluid with mediastinal shift requires insertion of a chest drain. Weaning from ventilation should be meticulous and slow as small variations in pH, PO₂ and PCO₂ will lead to persistent pulmonary hypertension. Weaning should commence with lowering of FiO₂, then peak pressures and finally respiratory rate.