Document Detail

Positive end-expiratory pressure differentially alters pulmonary hemodynamics and oxygenation in ventilated, very premature lambs.
MedLine Citation:
PMID:  15890759     Owner:  NLM     Status:  MEDLINE    
In mature lungs, elevated positive end-expiratory pressure (PEEP) reduces pulmonary blood flow (PBF) and increases pulmonary vascular resistance (PVR). However, the effect of PEEP on PBF in preterm infants with immature lungs and a patent ductus arteriosus is unknown. Fetal sheep were catheterized at 124 days of gestation (term approximately 147 days), and a flow probe was placed around the left pulmonary artery to measure PBF. At 127 days, lambs were delivered and ventilated from birth with a tidal volume of 5 ml/kg and 4-cmH(2)O PEEP; PEEP was changed to 0, 8, and 12 cmH(2)O in random order, returning to 4 cmH(2)O between each change. Increasing PEEP from 4 to 8 cmH(2)O and from 4 to 12 cmH(2)O decreased PBF by 20.5 and 41.0%, respectively, and caused corresponding changes in PVR; reducing PEEP from 4 to 0 cmH(2)O did not affect PBF. Despite decreasing PBF, increasing PEEP from 4 to 8 cmH(2)O and 12 cmH(2)O improved oxygenation of lambs. Increasing and decreasing PEEP from 4 cmH(2)O significantly changed the contour of the PBF waveform; at a PEEP of 12 cmH(2)O, end-diastolic flow was reduced by 82.8% and retrograde flow was reestablished. Although increasing PEEP improves oxygenation, it adversely affects PBF and PVR shortly after birth, alters the PBF waveform, and reestablishes retrograde flow during diastole.
Graeme R Polglase; Colin J Morley; Kelly J Crossley; Peter Dargaville; Richard Harding; David L Morgan; Stuart B Hooper
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2005-05-12
Journal Detail:
Title:  Journal of applied physiology (Bethesda, Md. : 1985)     Volume:  99     ISSN:  8750-7587     ISO Abbreviation:  J. Appl. Physiol.     Publication Date:  2005 Oct 
Date Detail:
Created Date:  2005-09-14     Completed Date:  2005-12-01     Revised Date:  2013-09-26    
Medline Journal Info:
Nlm Unique ID:  8502536     Medline TA:  J Appl Physiol (1985)     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1453-61     Citation Subset:  IM    
Fetal and Neonatal Research Group, Department of Physiology, Monash University, Australia.
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MeSH Terms
Animals, Newborn / physiology*
Fetus / physiology
Gestational Age*
Hemodynamics / physiology
Oxygen Consumption*
Positive-Pressure Respiration
Pulmonary Artery / physiology
Pulmonary Circulation / physiology*
Respiration, Artificial*
Vascular Resistance

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