Date: May 31, 2016 at 8:19:47 PM EDT
I have listened every detail of Dr. Stolar´s podcast.
He is right that nowadays pediatric surgeons don´t get much involved in the ventiatory management.
To learned about columbia´s ventilatory strategy was like an eye opener. Even though this group strategy has been published since 1995.
Although when I talked to my coligues here in Mexico about columbia´s strategy they have never used this strategy, In our group they change directly from convencional ventilation to HFOV.
I was pretty surprised about this. So I went back to the journals, to find out that only a Dr. Key´s group in Florida uses a strategy similar to theirs.
I have not found any other group that has reported a similar ventilatory strategy. They all used only conventional ventilation and switch directly to HFOV. Not even the 2016 Euroconsortium or the APSA outcomes and EBP CDH paper touches this issue, The recently published VICI trial used only conventional mode IMV or HFOV.
I am really interested to learn more about Dr. Stolar group ventilatory strategy since I believe this can be used in any NICU at least in Mexico.
Thank you very much
I have been very interested in CDH and I think this is one of the most comprehensive reviews in CDH.
Response from Dr. Stolar_
- I am pleased the podcast content was of value.
- We have been practicing and reporting on permissive hypercapnia/spontaneous ventilation since 1978. The most important report came from Mary Ellen Avery in the mid '80's where this strategy compared to 8 other NICU's had a vastly lower BPD incidence/discharge on oxygen, days on mechanical ventilation, lower neuro complications, and days to discharge for management of prematurity.
- The first report on using this strategy was by me and Peter Dillon in the late '80's with several more since. The work has been reproduced and reported by Wilson/Boston Children's and others.
- David Kays was my fellow and student which is where he learned the strategy he reports with similar outcomes in Florida.
- Bjorn Freckner/Eramsmus reported a European experience with similar results ion the mid '90's
- The Euoconsortium is a mix of many ventilator strategies and limited quality control with less favorable aggregate outcomes which is one of the reason antenatal Rx has its supporters in Europe.
- Dr. Penarrieta should feel free to contact me directly to discuss in detail....or have me bring religion to his neonatologists!