Inappropriate Response to Increased Plasma ADH during Mechanical Ventilation in Acute Respiratory Failure

Kumar, Anil; Pontoppidan, Henning; Baratz, Robert A.; Laver, Myron B.

doi:10.1097/00000542-197403000-00002

Cited by 61 publications

(13 citation statements)

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“…This is consistent with the hypothesis that the effects of AV on renal function are mediated through a PEEP-induced decrease in cardiac output resulting in lower values for mean BP (or pulse pressure) and renal blood flow (9,11,24). Although decreased pulmonary compliance might be expected to offer some protection from such PEEP-induced changes, this did not appear to be the case in our group of infants receiving AV, since values for mean BP and Ccr in those with HMD were just as low as values in infants who did not have HMD and who would be expected to have normal pulmonary compliance.…”

Section: Discussionsupporting

confidence: 91%

“…Such factors, as well as differences in gestational ages (4) and use of volume expansion (5) and drugs such as digoxin (3) make interpretation of these studies difficult. By contrast, studies of adult man and experimental animals in which conditions were more controlled, consistently demonstrated a relative salt retention with intermittent positive pressure ventilation (8)(9)(10)(11)(12)(13); results with NCPAP were more variable (8,10,11,13). In the present study total Na intakes were very similar in our two groups of infants, predominantly as parenteral NaCl.…”

Section: Discussioncontrasting

confidence: 63%

“…Others have reported urine volume to be decreased in association with AV in adult men (8)(9)(10) and experimental animals (1 1 -13), and also in association with severe respiratory distress in newborn infants (2). It is likely that baroreceptor-stimulated vasopressin release is responsible for the decreased urine volume with AV (8,9,13,24).…”

Section: Discussionmentioning

confidence: 96%

“…It is likely that baroreceptor-stimulated vasopressin release is responsible for the decreased urine volume with AV (8,9,13,24). Since severe hypoxemia also can stimulate vasopressin secretion (28), vasopressin also may have contributed to the decrease in urine volume of infants in earlier neonatal studies.…”

Section: Discussionmentioning

confidence: 99%

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The Effect of Assisted Ventilation on Creatinine Clearance and Hormonal Control of Electrolyte Balance in Very Low Birth Weight Infants

et al. 1986

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ABSTRACT. Because renal function and electrolyte balance are commonly altered in premature infants, particularly those requiring ventilatory support, we studied the influence of assisted ventilation on renal electrolyte and water excretion in infants with birth weights less than 1501 g during the 2 days after birth. Twenty-two infants receiving assisted ventilation, either as intermittent mandatory ventilation or nasal continuous positive airway pressure, were compared with 21 spontaneously ventilating infants of similar birthweight and gestational age. Mean (and SEM) creatinine clearance was lower ( p < 0.05) in the assisted ventilation group on day 1 (2.9 f 0.4 versus 4.1 f 0.4 ml/min/1.73 m2) and on day 2 (4.1 2 1.0 versus 6.8 + 0.8 ml/min/1.73 mZ, p = 0.05), and there was a correlation between creatinine clearance and mean blood pressure in both groups. Mean urine vasopressin was higher in the assisted ventilation group on the first day (360 f 86 versus 123 ? 30 pg/mg creatinine; p < 0.02) and correlated with higher urine osmolality. There were no differences in urine volume, in osmolar or free water clearances, or in the intake and urine excretion of sodium, potassium, and chloride. Plasma renin activity, urine aldosterone, and urine prostaglandin E2 were similar in both groups on both days. Neither the mode of assisted ventilation nor the cause of respiratory failure appeared to affect these results. (Pediatr Res 20: 447-452, 1986) Abbreviations PEEP. ~ositive end-ex~ired Dressure , -

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Section: Discussionsupporting

confidence: 91%

Section: Discussioncontrasting

confidence: 63%

Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 99%

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The Effect of Assisted Ventilation on Creatinine Clearance and Hormonal Control of Electrolyte Balance in Very Low Birth Weight Infants

et al. 1986

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“…This may reflect the development of meconium aspiration syndrome with relative hypoxemia and hypercapnia in five infants and/or the need for mechanical ventilation in 55% of this group (32,33). It was not unusual to find a fall in urinary AVP concomitant with an improvement in lung disease in individual cases; but there are presently too few cases to make any further comments.…”

Section: Discussionmentioning

confidence: 95%

Urinary Arginine Vasopressin: Pattern of Excretion in the Neonatal Period

et al. 1986

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ABSTRACT. The pattern of arginine vasopressin (AVP) secretion in the immediate neonatal period is unclear. Plasma concentrations of AVP are reflected by its urinary excretion, thus providing a noninvasive method for studying the pattern of AVP release in the neonate. In these studies, we determined the pattern of urinary AVP excretion (pU/ mg creatinine) during the first 2-4 days after birth in 78 neonates, 53 of whom had various prenatal and/or neonatal complications. In well term ( n = 12) and preterm (n = 13) infants mean urinary AVP excretion decreased gradually during the first 24-36 h after birth. Although term and preterm infants with perinatal asphyxia had highest initial levels of urinary A V P (>200 pU/mg creatinine) and a significant negative correlation with the 1-min Apgar score was obtained, their pattern of excretion was similar to respective controls. After delivery, elevated values for urinary AVP excretion were found among infants with neonatal courses complicated by intracranial hemorrhage, hypoxic encephalopathy, and pneumothorax. Urine osmolality did not correlate linearly with urinary AVP levels, but rather attained a maximum value of -400 mosmol/kg at urinary AVP levels <200 pU/mg creatinine and then plateaued. It is concluded that the decrease in urinary AVP excretion observed soon after birth generally reflects diminution of the hypersecretion of AVP during parturition; neonates with evidence of intrapartnm asphyxia initially have increased urinary AVP excretion; however, the pattern of excretion is similar to normal infants. During the neonatal period insults such a s pneumothorax and intracranial hemorrhage may cause hypersecretion of this hormone. (Pediatr Res 20: 103-108, 1986) Abbreviations AVP, arginine vasopressin HMD, hyaline membrane disease Cr, creatinine PV-IVH, periventricular-intraventricular hemorrhage Investigations of AVP, or antidiuretic hormone, during the perinatal period have been focused on both its renal and extrarenal actions. Although its potent pressor effect may be more important than its antidiuretic action during this period of adaptation (I), these and other physiologic roles for AVP remain

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Intermittent and Continuous Positive Pressure Ventilation

Suter¹

1983

Care of the Critically Ill Patient

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Inappropriate Response to Increased Plasma ADH during Mechanical Ventilation in Acute Respiratory Failure

Cited by 61 publications

References 0 publications

The Effect of Assisted Ventilation on Creatinine Clearance and Hormonal Control of Electrolyte Balance in Very Low Birth Weight Infants

The Effect of Assisted Ventilation on Creatinine Clearance and Hormonal Control of Electrolyte Balance in Very Low Birth Weight Infants

Urinary Arginine Vasopressin: Pattern of Excretion in the Neonatal Period

Intermittent and Continuous Positive Pressure Ventilation

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