| Cardiorespiratory effects of changes in end expiratory pressure in ventilated newborns. | |
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MedLine Citation:
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PMID: 17460022 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Positive pressure ventilation in premature infants can improve oxygenation but may diminish cerebral blood flow and cardiac output. Low superior vena cava (SVC) flow increases risk of intraventricular haemorrhage, and higher mean airway pressure is associated with low SVC flow. Whether this is a direct effect of positive pressure ventilation or a reflection of severity of lung disease is not known. This study aimed to determine if positive end expiratory pressure (PEEP) in ventilated newborns could be increased without clinically relevant cardiorespiratory changes. METHOD: Ventilated newborns were studied before and 10 min after increasing PEEP (5 cm H(2)O to 8 cmH(2)O) and again when PEEP returned to baseline. Echocardiographic and respiratory function measurements were collected during the intervention. RESULTS: In 50 infants, increased PEEP was associated with a non-significant difference in mean SVC flow of -5 ml/kg/min (95% CI -12 to 3 ml/kg/min) but a significant reduction in right ventricular output of 17 ml/kg/min (95% CI 5 to 28 ml/kg/min). The increase in lung compliance was non-significant (median difference 0.02 ml/cmH(2)O/kg) and the decrease in lung resistance (18 cmH(2)O/l/s; 95% CI 10 to 26 cm H(2)O/l/s) was significant. Changes (%) in lung compliance and SVC flow, when corrected for Paco(2), were positively associated (regression coefficient 0.4%; 95% CI 0.2% to 0.6%). CONCLUSION: A short-term increase in PEEP does not lead to significant changes in systemic blood flow, although 36% of infants in the present study had clinically important changes in flow (+/-25%). The intervention can improve dynamic lung function, especially airway resistance. Improvements in compliance tend to be associated with improvements in blood flow. |
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Authors:
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Koert A de Waal; Nick Evans; David A Osborn; Martin Kluckow |
Publication Detail:
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Type: Clinical Trial; Journal Article; Research Support, Non-U.S. Gov't Date: 2007-04-25 |
Journal Detail:
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Title: Archives of disease in childhood. Fetal and neonatal edition Volume: 92 ISSN: 1468-2052 ISO Abbreviation: Arch. Dis. Child. Fetal Neonatal Ed. Publication Date: 2007 Nov |
Date Detail:
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Created Date: 2007-10-22 Completed Date: 2007-12-11 Revised Date: 2013-06-06 |
Medline Journal Info:
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Nlm Unique ID: 9501297 Medline TA: Arch Dis Child Fetal Neonatal Ed Country: England |
Other Details:
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Languages: eng Pagination: F444-8 Citation Subset: AIM; IM |
Affiliation:
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Academic Medical Centre, Department of Neonatology, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands. k.a.dewaal@amc.nl |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Airway Resistance Blood Circulation* Cardiac Output Cerebrovascular Circulation Coronary Circulation Hemodynamics* Humans Infant, Newborn Linear Models Lung Compliance Positive-Pressure Respiration / adverse effects, methods* Respiratory Physiological Phenomena* Single-Blind Method |
| Comments/Corrections | |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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