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

Zannin, Emanuela; Doni, Daniela; Ventura, Maria Luisa; Fedeli, Tiziana; Rigotti, Camilla; Dellacà, Raffaele L.; Tagliabue, Paolo

doi:10.1016/j.jpeds.2016.09.015

Cited by 18 publications

(23 citation statements)

References 23 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Regular assessment of lung compliance is recommended, and a high index of suspicion for over-distension is warranted. TnECHO assessment of RV output, which declines with increasing distending pressure, may provide additional insight, though further study is required to identify if a predictable threshold exists (68,69). Indices of left heart filling and inferior vena cava distensibility may provide additional insights, but there is limited data regarding their validity.…”

Section: Approach To Respiratory Supportmentioning

confidence: 99%

Controversies in the identification and management of acute pulmonary hypertension in preterm neonates

Giesinger

Odame

et al. 2017

Pediatr Res

View full text Add to dashboard Cite

It is increasingly recognized that the abnormal physiologic consequences of pulmonary hypertension (PH) may contribute to poor cardiopulmonary health in premature babies. Conflicting literature has led to clinical uncertainty, pathological misinterpretation, and variability in treatment approaches among practitioners. There are several disorders with overlapping and interrelated presentations, and other disorders with a similar clinical phenotype but diverse pathophysiological contributors. In this review, we provide a diagnostic approach for acute hypoxemic respiratory failure in the preterm neonate, outline the pathophysiological conditions that may present as acute PH, and discuss the implications of high pulmonary vascular resistance (PVR) on the cardiovascular system. Although PVR and respiratory management are highly interrelated, there may be a population of preterm neonates in whom inhaled nitric oxide may improve illness severity and may relate to outcomes. A management approach based on physiology that considers common clinical conundrums is provided. A more comprehensive understanding of the physiology may help in informed decision-making in clinical situations where conclusive scientific evidence is lacking. Regardless, high-quality research is required, and appropriate definition of the target population is paramount. A thoughtful approach to cardiovascular therapy may also provide an avenue to improve neurodevelopmental outcomes while awaiting more clear answers.

show abstract

Section: Approach To Respiratory Supportmentioning

confidence: 99%

Controversies in the identification and management of acute pulmonary hypertension in preterm neonates

Giesinger

Odame

et al. 2017

Pediatr Res

View full text Add to dashboard Cite

show abstract

“…[13,14] Stepwise oxygenation-guided lung recruitment maneuvers (LRMs) can e ciently establish and stabilize lung capacity after HFOV initiation. [13][14][15] Studies have further con rmed that such LRMs had a low risk of lung hyperin ation and air leak syndrome, had no adverse cerebral events (e.g., intraventricular hemorrhage) and in addition, did not compromise cardiac function up to a critical level in preterm infants. [16] Therefore, LRMs are recommended when HFOV is initiated.…”

Section: Introductionmentioning

confidence: 99%

Regular Lung Recruitment Maneuvers during High-Frequency Oscillatory Ventilation in Extremely Preterm Infants: A Randomized Controlled Trial

Werther

Kueng

Aichhorn

et al. 2022

Preprint

View full text Add to dashboard Cite

Background Lung recruitment maneuvers (LRMs) improve lung volume at initiation of high-frequency oscillatory ventilation (HFOV), but it is unclear when to repeat LRMs. We evaluated the efficiency of scheduled LRMs. Methods In a randomized controlled trial, extremely preterm infants on HFOV received either LRMs at 12-hour intervals and when clinically indicated (intervention) or only when clinically indicated (control). The primary outcome was the cumulative oxygen saturation index (OSI) over HFOV time, limited to 7 days. Additionally, LRMs were analyzed with respect to OSI improvement. Results Fifteen infants were included in each group. The median (range) postmenstrual age and weight at HFOV start were 24+2 (23+0, 27+6) weeks and 615 (435, 920) g. The mean (SD) cumulative OSI was 4.95 (1.72) in the intervention versus 5.30 (2.08) in the control group (p=0.61). The mean (SD) number of LRMs in 12 hours was 1.3 (0.2) in the intervention versus 1.1 (0.5) in the control group (p=0.13). Performing LRM when FiO2>0.6 resulted in a mean OSI reduction of 3.6. Conclusion Regular versus clinically indicated LRMs were performed with equal frequency in preterm infants during HFOV, and consequently, no difference in lung volume was observed. LRMs seem to be most efficient at high FiO2. Trial registration ClinicalTrials.gov ID: NCT04289324 (28/02/2020).

show abstract

“…However, HFOV is increasingly used in neonatal intensive care unit (NICU), there is a little known about its hemodynamic effects 6 . The relatively high mean airway pressure (MAP) used in HFOV during recruitment procedure can affect the hemodynamics 7 . The studies about its hemodynamic impacts have inconsistent and conflicting results and it remains hazy as to what degree, if any, hemodynamic consequences ought to be foreseen when using HFOV 7–10 .…”

Section: Introductionmentioning

confidence: 99%

“…6 The relatively high mean airway pressure (MAP) used in HFOV during recruitment procedure can affect the hemodynamics. 7 The studies about its hemodynamic impacts have inconsistent and conflicting results and it remains hazy as to what degree, if any, hemodynamic consequences ought to be foreseen when using HFOV. [7][8][9][10] Therefore, a better understanding of its hemodynamic effects will definitely have a great impact on clinical decision making.…”

Section: Introductionmentioning

confidence: 99%

Hemodynamic effects of high‐frequency oscillatory ventilation in preterm neonates with respiratory distress syndrome

Ayoub

Elmashad

Rowisha

et al. 2020

Pediatric Pulmonology

View full text Add to dashboard Cite

Background: High-frequency oscillatory ventilation (HFOV) can have negative hemodynamic effects in neonates. We aimed to assess systemic, cerebral, and cardiac hemodynamic changes in preterm neonates with respiratory distress syndrome (RDS) on HFOV. Methods: This observational study was conducted from June 2017 until May 2019 on 100 preterm neonates with RDS that needed switching from conventional mechanical ventilation to HFOV. Initial and Follow up capillary blood gas, echocardiographic examination, cranial ultrasound, and Doppler study of cerebral, celiac, superior mesenteric, and renal arteries using resistive index (RI) were performed before, 24 h, and 72 h after the use of HFOV. Results: There was no statistically significant difference as regards cardiac function, heart rate, or intraventricular hemorrhage on follow up measurements. However blood pressure, left ventricular dimensions, and volumes statistically increased after HFOV. There was a statistically significant decrease in the pulmonary artery systolic pressure after the use of HFOV. After the use of HFOV, there was a statistically significant increase in the superior vena cava flow and left ventricular output while right ventricular output values initially increased then slightly decreased but still higher than the initial values. RI of cerebral, superior mesenteric, celiac, and renal arteries significantly decreased on follow up measurements which reflected increased blood flow in these arteries. Conclusion: HFOV had no negative effect on the cerebral, systemic, or cardiac hemodynamics when applied at optimum MAP. Therefore, concerns about negative hemodynamic effects of HFOV should not discourage the use of HFOV when deemed clinically indicated provided the use of optimum MAP.

show abstract

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

Cited by 18 publications

References 23 publications

Controversies in the identification and management of acute pulmonary hypertension in preterm neonates

Controversies in the identification and management of acute pulmonary hypertension in preterm neonates

Regular Lung Recruitment Maneuvers during High-Frequency Oscillatory Ventilation in Extremely Preterm Infants: A Randomized Controlled Trial

Hemodynamic effects of high‐frequency oscillatory ventilation in preterm neonates with respiratory distress syndrome

Contact Info

Product

Resources

About