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

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

Research output: Contribution to journalArticle

18 Citations (Scopus)

Abstract

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
Pages (from-to)9-13
Number of pages5
JournalNeonatology
Volume105
Issue number1
DOIs
StatePublished - Jan 1 2013

Fingerprint

Superior Vena Cava
Patent Ductus Arteriosus
Positive-Pressure Respiration
Premature Infants
Cerebrovascular Circulation
Transcutaneous Blood Gas Monitoring
Vascular Resistance
Gestational Age
Perfusion
Gases
Hemodynamics
Oxygen

Keywords

  • 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

Cite this

Effect of positive end-expiratory pressure on ductal shunting and systemic blood flow in preterm infants with patent ductus arteriosus. / Fajardo, Maria Florencia; Claure, Nelson R; Swaminathan, Sethuraman; Sattar, Sumbal; Vasquez, Amelia; D'Ugard, Carmen; Bancalari, Eduardo.

In: Neonatology, Vol. 105, No. 1, 01.01.2013, p. 9-13.

Research output: Contribution to journalArticle

@article{2b37bf9cd1d148a38532ab2b941accdc,
title = "Effect of positive end-expiratory pressure on ductal shunting and systemic blood flow in preterm infants with patent ductus arteriosus",
abstract = "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.",
keywords = "Left to right shunt, Patent ductus arteriosus, Positive end-expiratory pressure, Premature infant, Systemic blood flow",
author = "Fajardo, {Maria Florencia} and Claure, {Nelson R} and Sethuraman Swaminathan and Sumbal Sattar and Amelia Vasquez and Carmen D'Ugard and Eduardo Bancalari",
year = "2013",
month = "1",
day = "1",
doi = "10.1159/000355146",
language = "English",
volume = "105",
pages = "9--13",
journal = "Neonatology",
issn = "1661-7800",
publisher = "S. Karger AG",
number = "1",

}

TY - JOUR

T1 - Effect of positive end-expiratory pressure on ductal shunting and systemic blood flow in preterm infants with patent ductus arteriosus

AU - Fajardo, Maria Florencia

AU - Claure, Nelson R

AU - Swaminathan, Sethuraman

AU - Sattar, Sumbal

AU - Vasquez, Amelia

AU - D'Ugard, Carmen

AU - Bancalari, Eduardo

PY - 2013/1/1

Y1 - 2013/1/1

N2 - 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.

AB - 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.

KW - Left to right shunt

KW - Patent ductus arteriosus

KW - Positive end-expiratory pressure

KW - Premature infant

KW - Systemic blood flow

UR - http://www.scopus.com/inward/record.url?scp=84886737638&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84886737638&partnerID=8YFLogxK

U2 - 10.1159/000355146

DO - 10.1159/000355146

M3 - Article

C2 - 24193163

AN - SCOPUS:84886737638

VL - 105

SP - 9

EP - 13

JO - Neonatology

JF - Neonatology

SN - 1661-7800

IS - 1

ER -