Circulatory Studies in Clinical Hyaline Membrane Disease

Stahlman, Mildred T.; Blankenship, Willard J.; Shepard, Frank M.; Gray, Jaimie S.; Young, Wayne; Malan, A.F.

doi:10.1159/000240473

Cited by 56 publications

(5 citation statements)

References 14 publications

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“…However, in applying this concept the clinician must be confident that the infant being considered does not have a significant degree of shunting through fetal circulatory pathways; the large AaDo2 would then be interpreted as low FRC when in actuality it is due to shunting. It has been observed that many infants with RDS have transient shunting through the foramen ovale (20). Therefore, ideal monitoring of therapy would include the measurement of both FRC and AaDo2 to help distinguish between intra-pulmonary (secondary to atelectasis) and extra-pulmonary shunting (through fetal circulatory pathways).…”

Section: Discussionmentioning

confidence: 99%

The Functional Residual Capacity of Infants with Respiratory Distress Syndrome

1986

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Positive end-expiratory pressure (PEEP) is used in the treatment of infants with respiratory distress syndrome (RDS) to prevent atelectasis, recruit alveolar space and return the functional residual capacity (FRC) toward normal volumes. This study determined the FRC range of 15 prematurely born infants with RDS receiving PEEP. Ventilator settings were controlled clinically using predominantly results of arterial blood-gas analyses. Measurements of arterial blood-gases and FRC (N2 washout) were made during the infants' second day of life. The FRC of the infants on a PEEP of 4.5 +/- 1.3 cmH2O ranged widely from 3 to 33 ml/kg with a mean of 14.5 ml/kg; 17 +/- 2 ml/kg was considered normal. The FRC was within one SD of the mean in only three of the 15 infants (20%) and outside of two SD of normal in seven (47%). A linear regression of calculated alveolar-arterial oxygen gradient (AaDo2) with FRC yielded a correlation coefficient r = 0.825. The AaDo2 values could be used to identify six of the seven infants having FRC outside of 2SD from normal. We conclude that convential methods of PEEP selection for infants with RDS seldom result in a normalization of FRC. Calculated AaDo2 values may be used to identify most RDS infants with FRC widely divergent from normal values.

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Section: Discussionmentioning

confidence: 99%

The Functional Residual Capacity of Infants with Respiratory Distress Syndrome

1986

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“…7 Studies using invasive methods have demonstrated evidence for the presence of right-to-left shunting, pulmonary hypertension, and pulmonary hypoperfusion in large premature newborns with birth weights Ն1250 g and RDS. [8][9][10] In a select group of premature newborns, pulmonary circulation is capable of developing clinically significant persistent pulmonary hypertension.…”

mentioning

confidence: 99%

Neonatal-Perinatal Risk Factors for the Development of Persistent Pulmonary Hypertension of the Newborn in Preterm Newborns

Muraskas

Juretschke²,

Weiss³

et al. 2001

Am J Perinatol

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There is a long-held belief that preterm newborns lack sufficient arteriolar musculature to maintain a prolonged elevated pulmonary vascular resistance (PVR) after birth. Net ductal flow is thought to be minimal, with the developing pulmonary circulation incapable of significant vasoconstriction. We identified retrospectively 15 premature newborns over a 10-year period weighing < or = 1500 g and with a gestational age of < or = 30 weeks with documented persistent pulmonary hypertension of the newborn (PPHN) in the first 24 hours after birth. We matched 36 newborns of similar weight and gestation with no clinical evidence of shunting. The control group weaned to an FiO2 < or = 0.50 by 12 hours after birth. Despite similar gestational ages, the PPHN group (n = 15) had significantly higher birth weights than the control group (n = 36). The duration of ruptured membranes, maternal tobacco use, and use of antenatal steroids were significantly higher in the PPHN group. We speculate that these three factors might act in a synergistic relationship with which to accelerate pulmonary vascular smooth muscle development in premature newborns.

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“…that receiving <10ml/kg pre-curare. It could be argued that systemic hypotension pre-curare need not identify those with the worst shunting and indeed that systemic hypertension from increased foramen ovale shunting and increased left ventricular output has been associated with a poorer outcome in IRDS (3). If adequate volume support is given post-curare, any lowering of the left ventricular afterload may, in conjunction with the improved preload of oxygenated blood resulting from pulmonary vasodilation, improve left ventricular function and reduce shunting.…”

Section: Discussionmentioning

confidence: 99%

Curare in the treatment of pulmonary hypertension as it occurs in the idiopathic respiratory distress syndrome

Hutchison

1980

J Paediatr Child Health

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Thirteen infants with pulmonary hypertension occurring in the course of the idiopathic respiratory distress syndrome received curare on 26 occasions. The histaminic effect of curare in relieving the shunting was minimal, whilst its muscle relaxant properties might be important in determining the outcome. The survival rate was 54%all those dying having intraventricular haemorrhage. The alveolar-arterial oxygen tension gradient proved the most sensitive index of shunting whilst the arterial/alveolar oxygen tension ratio and the arterial oxygen tensionlfraction of inspired oxygen ratio might prove more useful clinically. Key WordsCurare, pulmonary hypertension and hypoperfusion, idiopathic respiratory distress syndrome, intraventricular haemorrhage, indices of shunting, severe hypoxaemia.

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Circulatory Studies in Clinical Hyaline Membrane Disease

Cited by 56 publications

References 14 publications

The Functional Residual Capacity of Infants with Respiratory Distress Syndrome

The Functional Residual Capacity of Infants with Respiratory Distress Syndrome

Neonatal-Perinatal Risk Factors for the Development of Persistent Pulmonary Hypertension of the Newborn in Preterm Newborns

Curare in the treatment of pulmonary hypertension as it occurs in the idiopathic respiratory distress syndrome

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