Document Detail


Non-invasive measurement of reduced ventilation:perfusion ratio and shunt in infants with bronchopulmonary dysplasia: a physiological definition of the disease.
MedLine Citation:
PMID:  16798787     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: An objective definition of bronchopulmonary dysplasia (BPD) is required to interpret trial outcomes and provide a baseline for prognostic studies. Current definitions do not quantify disease severity. The cardinal measures of impaired gas exchange are a reduced ventilation:perfusion ratio (V(A):Q) and increased right to left shunt. These can be determined non-invasively by plotting arterial oxygen saturation (Spo(2)) against inspired oxygen pressure (PIo(2)).
AIMS: To describe the reduced V(A):Q and shunt in infants with BPD and evaluate these as graded measures of pulmonary dysfunction.
METHODS: 21 preterm infants with BPD were studied. PIo(2) was changed stepwise to vary Spo(2) between 86% and 94%. Pairs of PIo(2) and Spo(2) data points for each infant were plotted and analysed to derive reduced V(A):Q ratio and shunt.
RESULTS: In every infant, the Spo(2) versus PIo(2) curve was shifted to the right of the normal because of a reduced V(A):Q. The mean (SD) shift was 16.5 (4.7) kPa (normal 6 kPa). Varying degrees of shunt were also present, but these were less important in determining Spo(2) within the studied range. The degree of shift was strongly predictive of the PIo(2) required to achieve any Spo(2) within the range 86-94% (R(2)>0.9), permitting shift and V(A):Q to be determined from a single pair of PIo(2) and SpO(2) values in this range.
CONCLUSIONS: The predominant gas exchange impairment in BPD is a reduced V(A):Q, described by the right shift of the Spo(2) versus PIo(2) relationship. This provides a simpler method for defining BPD, which can grade disease severity.
Authors:
D Quine; C M Wong; E M Boyle; J G Jones; B J Stenson
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Publication Detail:
Type:  Journal Article     Date:  2006-06-23
Journal Detail:
Title:  Archives of disease in childhood. Fetal and neonatal edition     Volume:  91     ISSN:  1359-2998     ISO Abbreviation:  Arch. Dis. Child. Fetal Neonatal Ed.     Publication Date:  2006 Nov 
Date Detail:
Created Date:  2006-10-23     Completed Date:  2007-03-05     Revised Date:  2013-06-07    
Medline Journal Info:
Nlm Unique ID:  9501297     Medline TA:  Arch Dis Child Fetal Neonatal Ed     Country:  England    
Other Details:
Languages:  eng     Pagination:  F409-14     Citation Subset:  AIM; IM    
Affiliation:
Neonatal Unit, Royal Infirmary of Edinburgh, Edinburgh, UK.
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MeSH Terms
Descriptor/Qualifier:
Bronchopulmonary Dysplasia / diagnosis,  physiopathology*
Humans
Infant, Newborn
Infant, Premature, Diseases / diagnosis,  physiopathology*
Oxygen / blood
Partial Pressure
Ventilation-Perfusion Ratio / physiology*
Chemical
Reg. No./Substance:
7782-44-7/Oxygen
Comments/Corrections

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