Relationship between Mean Airways Pressure, Lung Mechanics, and Right Ventricular Output during High-Frequency Oscillatory Ventilation in Infants

Objective To characterize changes in lung mechanics and right ventricular output (RVO) during incremental/decremental continuous distending pressure (CDP) maneuvers in newborn infants receiving high-frequency oscillatory ventilation, with the aim of evaluating when open lung maneuvers are needed and...

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Bibliographic Details
Published in:The Journal of pediatrics 2017-01, Vol.180, p.110-115
Main Authors: Zannin, Emanuela, PhD, Doni, Daniela, MD, Ventura, Maria Luisa, MD, Fedeli, Tiziana, MD, Rigotti, Camilla, PhD, Dellacá, Raffaele L., PhD, Tagliabue, Paolo E., MD
Format: Article
Language:English
Subjects:
Cardiac Output
Doppler echocardiography
Female
forced oscillation technique
High-Frequency Ventilation - methods
Humans
Infant, Newborn
Male
mechanical ventilation
Pediatrics
Pressure
pulmonary hemodynamics
Respiratory Mechanics
Ventricular Function, Right
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Summary:Objective To characterize changes in lung mechanics and right ventricular output (RVO) during incremental/decremental continuous distending pressure (CDP) maneuvers in newborn infants receiving high-frequency oscillatory ventilation, with the aim of evaluating when open lung maneuvers are needed and whether they are beneficial. Study design Thirteen infants on high-frequency oscillatory ventilation were studied with a median (IQR) gestational age of 261 (253 -291 ) weeks and median (IQR) body weight of 810 (600-1020) g. CDP was increased stepwise from 8 cmH2 O to a maximum pressure and subsequently decreased until oxygenation deteriorated or a CDP of 8 cmH2 O was reached. The lowest CDP that maintained good oxygenation was considered the clinically optimal CDP. At each CDP, the following variables were evaluated: oxygenation, respiratory system reactance (Xrs), and RVO by Doppler echocardiography. Results At maximal CDP reached during the trial, 19 [1] cmH2 O (mean [SEM]), oxygenation markedly improved, and Xrs and RVO decreased. During deflation, oxygenation remained stable over a wide range of CDP settings, Xrs returned to the baseline values, and RVO increased but the baseline values were not readily restored in all patients. Conclusion These results suggest that Xrs and RVO are more sensitive than oxygenation to overdistension and they may be useful in clinical practice to guide open lung maneuvers.
ISSN:0022-3476
1097-6833
DOI:10.1016/j.jpeds.2016.09.015