Document Detail


Haemodynamic effects of altering arterial oxygen saturation in preterm infants with respiratory failure.
MedLine Citation:
PMID:  10325781     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
AIMS: To examine the haemodynamic effects of brief alteration in arterial oxygenation in preterm infants with respiratory failure. METHODS: Eighteen preterm infants with respiratory failure, aged 9-76 hours, underwent detailed Doppler echocardiographic assessment at 86%, 96%, and 100% SaO2, achieved by altering the FIO2. Sixteen were receiving intermittent positive pressure ventilation, median FIO2 0.45 (0.20-0.65), median mean airway pressure 12 cm H2O (0-20). SaO2 was stable for 15 minutes at each stage. Four parameters of pulmonary arterial pressure were measured: peak velocity of tricuspid regurgitation and peak velocity of left to right ductal flow, TPV:RVET ratio and PEP:RVET ratio, measured at the pulmonary valve, along with flow velocity integrals at the aortic and pulmonary valves, and systemic arterial pressure. Ductal size was graded into closed, small, moderate, large with imaging, pulsed and continuous wave Doppler. RESULTS: Between 86% and 96% SaO2, there were no consistent changes, but in three of the 12 with a patent ductus arteriosus (PDA) there was ductal constriction, with complete closure in one. Between 96% and 100% SaO2, peak ductal flow velocity rose significantly in four of eight with a PDA. Ductal constriction occurred in four infants; in three this was associated with a significant fall in aortic flow integral and a rise in aortic pressure (4-6 mm Hg). Overall, 11 infants went from 86% to 100% SaO2 and pulmonary arterial pressure fell significantly in seven. CONCLUSION: A brief rise in SaO2 within the range maintained by most neonatal units can cause significant ductal constriction. The fall in pulmonary arterial pressure with 100% SaO2 seen in most infants was associated with a fall in pulmonary blood flow (or no change), rather than a rise, indicating that the dominant haemodynamic effect was ductal constriction rather than pulmonary vasodilation.
Authors:
J R Skinner; S Hunter; C F Poets; D W Milligan; D Southall; E N Hey
Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Archives of disease in childhood. Fetal and neonatal edition     Volume:  80     ISSN:  1359-2998     ISO Abbreviation:  Arch. Dis. Child. Fetal Neonatal Ed.     Publication Date:  1999 Mar 
Date Detail:
Created Date:  1999-05-20     Completed Date:  1999-05-20     Revised Date:  2009-11-18    
Medline Journal Info:
Nlm Unique ID:  9501297     Medline TA:  Arch Dis Child Fetal Neonatal Ed     Country:  ENGLAND    
Other Details:
Languages:  eng     Pagination:  F81-7     Citation Subset:  AIM; IM    
Affiliation:
Department Paediatric Cardiology, Freeman Hospital, Newcastle upon Tyne. JSkinner@AHSL.co.nz
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MeSH Terms
Descriptor/Qualifier:
Confidence Intervals
Ductus Arteriosus, Patent / blood*,  physiopathology,  therapy
Echocardiography, Doppler
Hemodynamics*
Humans
Hyaline Membrane Disease / blood*,  physiopathology,  therapy
Infant, Newborn
Infant, Premature / blood
Intermittent Positive-Pressure Ventilation
Oxygen / blood*
Pulmonary Artery
Pulmonary Wedge Pressure
Regional Blood Flow
Chemical
Reg. No./Substance:
7782-44-7/Oxygen
Comments/Corrections

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


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