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. 2017 Jan;180:110-115.
doi: 10.1016/j.jpeds.2016.09.015. Epub 2016 Oct 10.

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

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

Emanuela Zannin et al. J Pediatr. .

Abstract

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 cmH2O to a maximum pressure and subsequently decreased until oxygenation deteriorated or a CDP of 8 cmH2O 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] cmH2O (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.

Keywords: Doppler echocardiography; forced oscillation technique; infant, newborn; mechanical ventilation; pulmonary hemodynamics.

Comment in

  • Ventilating smarter, not harder.
    Goodman DM. Goodman DM. J Pediatr. 2017 Jan;180:2-3. doi: 10.1016/j.jpeds.2016.11.026. J Pediatr. 2017. PMID: 28010794 No abstract available.

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