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High altitude simulation testing in patients with congenital diaphragmatic hernia.

Authors :
Whitlock AE
Sheils CA
Zalieckas JM
Visner G
Mullen M
Studley M
Lemire L
Buchmiller TL
Source :
Journal of pediatric surgery [J Pediatr Surg] 2022 Feb; Vol. 57 (2), pp. 195-198. Date of Electronic Publication: 2021 Oct 29.
Publication Year :
2022

Abstract

Aim of Study: Congenital Diaphragmatic Hernia (CDH) is associated with lung hypoplasia and pulmonary hypertension. Many patients receive care in specialty centers requiring air travel upon discharge and for subsequent follow-up care. Premature infants can experience significant hypoxia in flight, but this has not been studied in the CDH population. This report describes our center's experience with simulated altitude testing among CDH patients.<br />Methods: In a single center retrospective cohort study, CDH patients who underwent a High Altitude Simulation Test (HAST) from 2006 to 2019 were analyzed. HAST simulates increased altitude by reducing oxygen tension to an FIO2 of 0.15. Patients were tested only when flight was anticipated. Patients requiring oxygen were challenged on their baseline requirement. To pass, patients had to maintain oxygen saturation > 90%, and 94% if diagnosed with pulmonary hypertension. Supplemental oxygen was titrated as needed to achieve this goal.<br />Results: Of twenty patients tested, only six (30%) passed on their first attempt. Ten (50%) eventually passed, after an average of 3.2 additional attempts over 1.8 years. No patient passed initially who utilized ECMO support, diaphragmatic agenesis, or had elevated right ventricular pressure on echocardiogram. All patients achieved the targeted SpO2 with supplemental oxygen.<br />Conclusion: CDH patients experience hypoxia when exposed to the simulated hypobaric nature of air travel and therefore may become hypoxic in flight, requiring oxygen supplementation. Disease severity seems to correlate with risk of in-flight hypoxia. This data suggests that CDH patients should be screened to assess their need for supplemental oxygen to ensure safe air travel.<br />Level of Evidence: Level 4 case series.<br /> (Copyright © 2021 Elsevier Inc. All rights reserved.)

Details

Language :
English
ISSN :
1531-5037
Volume :
57
Issue :
2
Database :
MEDLINE
Journal :
Journal of pediatric surgery
Publication Type :
Academic Journal
Accession number :
34865833
Full Text :
https://doi.org/10.1016/j.jpedsurg.2021.10.044