UMEM Educational Pearls


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?


Congenital diaphragmatic hernia
Congenital diaphragmatic hernia
  • 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:
  1. Inability to maintain pre-ductal PaO2 saturations >85 percent or post-ductal PaO2 >30 mmHg
  2. Peak inspiratory pressure >28 cm H2O or mean airway pressure >15 cm H2O
  3. Hypotension that is resistant to fluid and inotropic support
  4. Inadequate oxygen delivery with persistent metabolic acidosis


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