الفهرس | Only 14 pages are availabe for public view |
Abstract Stabilization of cardiorespiratory system. Endotracheal intubation is critical, nasogastric or orogastric tube placement, Permissive hypercapnia and stable hypoxemia (>80%), associated with survival of 76%. Delayed repair (24 to 72 hours) improves survival when compared with early emergent repair. Allows stabilization of the infant before surgical repair. 1/3 of patients will require ECMO. Reports of 70% survival by Bohn with early use of HFOV and ECMO for patients unable to be stabilized on reasonable ventilatory setting (pH.7.25, Peak Pressures <30 cm H2O, pre-ductal SO2 >90% with FiO2 <60%). Inhaled nitric oxide (iNO) beneficial in isolated PPHN. Careful attention to right sided heart failure increases survival by 10%. Finally, the introduction of ECMO and HFOV, in parallel with advances in other aspects of treatment, improved the results and the top institutions reported survivals approaching 90% although, sometimes, their statistics excluded chromosomal aberrations, multiple malformations and even some patients that did not reach surgery. |