Document Detail

Cardiorespiratory effects of changes in end expiratory pressure in ventilated newborns.
MedLine Citation:
PMID:  17460022     Owner:  NLM     Status:  MEDLINE    
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.
Koert A de Waal; Nick Evans; David A Osborn; Martin Kluckow
Publication Detail:
Type:  Clinical Trial; Journal Article; Research Support, Non-U.S. Gov't     Date:  2007-04-25
Journal Detail:
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:
Created Date:  2007-10-22     Completed Date:  2007-12-11     Revised Date:  2013-06-06    
Medline Journal Info:
Nlm Unique ID:  9501297     Medline TA:  Arch Dis Child Fetal Neonatal Ed     Country:  England    
Other Details:
Languages:  eng     Pagination:  F444-8     Citation Subset:  AIM; IM    
Academic Medical Centre, Department of Neonatology, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
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MeSH Terms
Airway Resistance
Blood Circulation*
Cardiac Output
Cerebrovascular Circulation
Coronary Circulation
Infant, Newborn
Linear Models
Lung Compliance
Positive-Pressure Respiration / adverse effects,  methods*
Respiratory Physiological Phenomena*
Single-Blind Method

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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