Mechanisms for episodes of hypoxemia in preterm infants undergoing mechanical ventilation

Juan M. Bolivar, Tilo Gerhardt, Alvaro Gonzalez, Helmut Hummler, Nelson R Claure, Ruth Everett-Thomas, Eduardo Bancalari

Research output: Contribution to journalArticle

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Abstract

Objective: To ascertain possible mechanisms implicated in the development of transient episodes of hypoxemia (oxygen saturation <85%) frequently observed in preterm infants undergoing mechanical ventilation, even after the acute phase of respiratory failure has passed. Study design: Tidal flow, airway and esophageal pressure, and oxygen saturation were continuously recorded in 10 infants (mean ± SD, birth weight 733 ± 149 gm, gestational age 25.5 ± 2.2 weeks, age 26.3 ± 11.9 days) who had repeated episodes of hypoxemia without any evident cause. Measurements of minute ventilation (v̇E), inspiratory compliance (Ci), and inspiratory resistance (Ri) were compared before and during episodes of hypoxemia. Results: All episodes of hypoxemia were preceded by an active exhalation that produced a mean decrease in end-expiratory lung volume of 6.4 ± 2.8 ml/kg. The reduction in lung volume was immediately followed by a sudden decrease in tidal flow and volume, despite continuation of mechanical ventilation at the same rate and peak pressure. The resulting hypoventilation was associated with a drop in Ci to approximately one half and an increase in Ri to more than double the baseline values. Approximately 30 seconds after the beginning of hypoventilation, the arterial oxygen saturation reached a hypoxemic level (oxygen saturation <85%). Conclusion: Most hypoxemic episodes were triggered by an expiratory effort that produced a large decrease in lung volume. This reduction in lung volume probably leads to closure of small airways and the development of intrapulmonary shunts, which would explain the rapid development of hypoxemia. (J PEDIATR 1995;127:767-73).

Original languageEnglish
Pages (from-to)767-773
Number of pages7
JournalThe Journal of pediatrics
Volume127
Issue number5
DOIs
StatePublished - Jan 1 1995
Externally publishedYes

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Artificial Respiration
Premature Infants
Oxygen
Hypoventilation
Pneumonectomy
Exhalation
Pressure
Lung
Tidal Volume
Birth Weight
Respiratory Insufficiency
Gestational Age
Compliance
Ventilation
Hypoxia

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

Mechanisms for episodes of hypoxemia in preterm infants undergoing mechanical ventilation. / Bolivar, Juan M.; Gerhardt, Tilo; Gonzalez, Alvaro; Hummler, Helmut; Claure, Nelson R; Everett-Thomas, Ruth; Bancalari, Eduardo.

In: The Journal of pediatrics, Vol. 127, No. 5, 01.01.1995, p. 767-773.

Research output: Contribution to journalArticle

Bolivar, Juan M. ; Gerhardt, Tilo ; Gonzalez, Alvaro ; Hummler, Helmut ; Claure, Nelson R ; Everett-Thomas, Ruth ; Bancalari, Eduardo. / Mechanisms for episodes of hypoxemia in preterm infants undergoing mechanical ventilation. In: The Journal of pediatrics. 1995 ; Vol. 127, No. 5. pp. 767-773.
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N2 - Objective: To ascertain possible mechanisms implicated in the development of transient episodes of hypoxemia (oxygen saturation <85%) frequently observed in preterm infants undergoing mechanical ventilation, even after the acute phase of respiratory failure has passed. Study design: Tidal flow, airway and esophageal pressure, and oxygen saturation were continuously recorded in 10 infants (mean ± SD, birth weight 733 ± 149 gm, gestational age 25.5 ± 2.2 weeks, age 26.3 ± 11.9 days) who had repeated episodes of hypoxemia without any evident cause. Measurements of minute ventilation (v̇E), inspiratory compliance (Ci), and inspiratory resistance (Ri) were compared before and during episodes of hypoxemia. Results: All episodes of hypoxemia were preceded by an active exhalation that produced a mean decrease in end-expiratory lung volume of 6.4 ± 2.8 ml/kg. The reduction in lung volume was immediately followed by a sudden decrease in tidal flow and volume, despite continuation of mechanical ventilation at the same rate and peak pressure. The resulting hypoventilation was associated with a drop in Ci to approximately one half and an increase in Ri to more than double the baseline values. Approximately 30 seconds after the beginning of hypoventilation, the arterial oxygen saturation reached a hypoxemic level (oxygen saturation <85%). Conclusion: Most hypoxemic episodes were triggered by an expiratory effort that produced a large decrease in lung volume. This reduction in lung volume probably leads to closure of small airways and the development of intrapulmonary shunts, which would explain the rapid development of hypoxemia. (J PEDIATR 1995;127:767-73).

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