Effect of positive end-expiratory pressure on ductal shunting and systemic blood flow in preterm infants with patent ductus arteriosus

Maria Florencia Fajardo, Nelson Claure, Sethuraman Swaminathan, Sumbal Sattar, Amelia Vasquez, Carmen D'Ugard, Eduardo Bancalari

Research output: Contribution to journalArticle

18 Scopus citations


Background: Left to right (L-R) shunting through a patent ductus arteriosus (PDA) can reduce systemic and cerebral blood flow in preterm infants. To minimize this, the positive end-expiratory pressure (PEEP) is often raised to increase pulmonary vascular resistance and reduce L-R shunting. The effects of this maneuver on systemic and cerebral hemodynamics and oxygenation are not well documented. Objective: To compare the effects of different PEEP on the left ventricular output (LVO), superior vena cava (SVC) flow, LVO/SVC flow ratio, cerebral oxygenation (CrSO2) and gas exchange in mechanically ventilated preterm infants with PDA. Methods: Sixteen mechanically ventilated infants of 23-30 weeks' gestational age with L-R shunting through the PDA were studied. Ultrasound measurements of LVO and SVC flow, CrSO2, arterial oxygen saturation and transcutaneous CO2 tension (TcPCO2) obtained at PEEP of 2 and 8 cm H2O were compared with baseline values at 5 cm H2O. Results: There was a small but significant reduction in LVO and the LVO/SVC flow ratio at PEEP of 8 compared to 5 cm H 2O. SVC flow and CrSO2 did not differ significantly. Conclusions: Increasing PEEP to 8 cm H2O in ventilated preterm infants with a PDA produced a modest decrease in L-R ductal shunting as indicated by a lower LVO/SVC flow ratio. The higher PEEP did not have a significant effect on cerebral perfusion or oxygenation.

Original languageEnglish (US)
Pages (from-to)9-13
Number of pages5
Issue number1
StatePublished - Dec 2013



  • Left to right shunt
  • Patent ductus arteriosus
  • Positive end-expiratory pressure
  • Premature infant
  • Systemic blood flow

ASJC Scopus subject areas

  • Developmental Biology
  • Pediatrics, Perinatology, and Child Health

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