Previous studies from our institution have shown that neonates with
congenital diaphragmatic hernia (CDH), whose best postductal PaO2 (BPDPO2) was less than 100 mm Hg while on maximal conventional
mechanical ventilation (CMV), had a mortality exceeding 90%. When combined with
extracorporeal membrane oxygenation (ECMO), the mortality rose to 100% in those infants who developed hypercarbia following decannulation. Historically, those patients have required increasing
ventilator support, leading to iatrogenic lung damage, and eventual death. Intratracheal pulmonary ventilation (ITPV) using the reverse thrust
catheter (RTC) developed by Kolobow incorporates a continuous flow of humidified gas through a reverse Venturi
catheter positioned at the distal end of the endotracheal tube. In animal studies, ITPV was shown to result in a reduced physiological dead-space (VD), to facilitate expiration, and to enhance CO2 elimination. In our current study, we have applied ITPV in two neonates with CDH who could not be weaned from ECMO because of uncontrollable
hypercapnia, and who met above criteria for 100% mortality. In both cases, ITPV restored normal PaCO2 at low peak inspiratory pressure (PIP) with a substantial decrease in VD. We believe ITPV is suited to ventilating newborns with CDH in whom
barotrauma is known to be common. Beyond its present use, ITPV may be useful to ventilate children with other forms of
respiratory failure, and should be so considered along with other now available methods of mechanical pulmonary ventilation.