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Question
3 month-old male presents with severe respiratory distress; oxygen saturation is 81% (on room air), he is grunting, and there are no breath sounds on the left. What's the diagnosis?
Answer
Congenital diaphragmatic hernia
Congenital diaphragmatic hernia
Management:
- Aggressive fluid and vasopressor support
- Early intubation and airway protection should be considered in severe cases; minimize BVM given the risk of gastric distention.
- NG tube decompressing of the stomach will help the ventilation/oxygenation process.
- ECMO may be considered if conventional therapy has failed and any one of the following criteria is met:
- Inability to maintain pre-ductal PaO2 saturations >85 percent or post-ductal PaO2 >30 mmHg
- Peak inspiratory pressure >28 cm H2O or mean airway pressure >15 cm H2O
- Hypotension that is resistant to fluid and inotropic support
- Inadequate oxygen delivery with persistent metabolic acidosis
References
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