Poster - 86
The cross-monitoring in congenital diaphragmatic hernia patient
Purpose: To emphasize the importance of cross-monitoring in patient care with congenital diaphragmatic hernia Case: The intubeted male patient with congenital diaphragmatic hernia which diagnosed at 6 month of gestation an was born by C/S at 37 gestation week admitted to NlCU. Head circumference was 32cm, height 48.5 cm, birth weight 2600g. Intubated oxygen concentrations: 100, respiratory rate 90, PEEP: 5, PEEP higher pressure: 16 and SpO2 of 93%. İn physical examination there was increased anteroposterior diameter of the thorax, the abdomen was sunken. İn Chest x-ray, the stomach were localized in the thorax. After providing hemodynamic stabilization of the patient, it was given 30 per bed position. To prevent the heat and trans-epidermal water loss and provide isolation from the environment the patient was ripe with stretch film. Antibiotics, sedative agents, muscle relaxants, and pulmonary vasodilator was started. The ventilatory parameteres were determined according to the blood gas values. To ensure airway patency oral and tracheal aspiration were performed. Monitoring of the patient's were made of cross extremities. İn infants with CDH the best marker of oxygenation is the difference between the postductal preductal oxygen measurement. İn clinical practice, transcutaneous O2 saturation from preduktal and postductal right hand and left foot must be made. And oxygen saturation equal to 85% or higher is accepteble. Result: İt may be the difference between preductal and postductal blood pressure and oxygen values in patients with congenital diaphragmatic hernia due to pulmonary hypertension wich developed during the intrautherine preriod. With the cross monitoring at postnatal period this situation are recognized at an early stage.