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; m inimize 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: Inab ility 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