Respiratory system compliance and postoperative ventilator dependence in neonates with left-sided congenital diaphragmatic hernia

Purpose. The purpose of this prospective consecutive patient study was to test if perioperative respiratory system compliance of patients undergoing surgical repair of congenital diaphragmatic hernia (CDH) can predict the need for prolonged postoperative mechanical ventilation. Methods. All neonates over 35 weeks of gestation who had surgical repair of left-sided CDH between July 1994 and December 1996 (n = 10) were included in this study. Static respiratory system compliance (C_rs) was measured by the passive occlusion method with muscle relaxation before (C_pre) and after (C_post) surgical repair of left-sided CDH. We examined the relationship between respiratory system compliance and postoperative ventilator-dependent duration. Results. The mean birthweight-corrected C_post was lower than that of birthweight-corrected C_pre (0.41 ± 0.18 vs 0.54 ± 0.18 ml·cmH₂O⁻¹·kg⁻¹, P = 0.04). One neonate died on postoperative day 31 from intraventricular hemorrhage, and the other nine neonates survived. The patient who died was excluded from the rest of our calculations. The ventilator-dependent duration was 16.7 ± 12.3 days. The postopera-tive ventilator-dependent duration was longer when the birthweight-corrected C_post was smaller, with a significant correlation between these parameters (P = 0.006). Conclusion. C_post, but not C_pre, may be useful to predict the need for prolonged postoperative mechanical ventilation in neonates with left-sided CDH. Received: May 31, 2000 / Accepted: February 21, 2001