Fellow Physician Baylor College of Medicine Houston, Texas, United States
Background: Congenital Diaphragmatic Hernia (CDH) presents a complex clinical challenge, combining respiratory failure and pulmonary hypertension due to developmental abnormalities of the pulmonary vascular bed. Traditional treatment strategies have primarily centered on ventilation and optimizing pulmonary vascular resistance (PVR). Nevertheless, recent insights into the pathophysiology of left ventricular dysfunction in CDH has illuminated the need for tailored, echocardiogram guided hemodynamic management. Objective: Our objective is to conduct a comprehensive review of the existing literature on hemodynamic management and the use of vasoactive medications in neonates with CDH and to formulate consensus guidelines on specific recommendations for hemodynamic management in CDH. Design/Methods: We will perform a comprehensive search of Medline through OVID using Medical Subject Headings (MeSH) terms, including both retrospective and prospective studies, review articles and case series. We will exclude conference abstracts and letters to the editor/commentaries. Initial screening will identify studies that focus on hemodynamic support in CDH neonates, with data extraction related to vasoactive medication usage and the methods employed in clinical decision-making. The secondary outcome assessed will be mortality or need for ECMO. Methodological quality assessment tools will be applied to ensure the robustness of the included studies. Following extensive literature review, the group leaders will develop recommendations that are firmly grounded in current evidence. To assess the level of agreement and support for these recommendations among group members, a Likert scale ranging from 0 to 100 will be employed. The criterion for consensus is set at a score of > 85 on the Likert scale. This structured approach will ensure that the resultant guidelines for hemodynamic support in CDH neonates is not only drawn from a wealth of evidence but also with strong support from the collective expertise of the focus group.
