Pulmonary arterial resistance and compliance in preterm infants

Okada, Seigo; Muneuchi, Jun; Nagatomo, Yusaku; Watanabe, Mamie; Iida, Chiaki; Shirouzu, Hiromitsu; Matsuoka, Ryohei; Joo, Kunitaka

doi:10.1016/j.ijcard.2017.06.056

Cited by 10 publications

(11 citation statements)

References 28 publications

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“…In CHD patients with such a pulmonary vascular condition, hemodynamic modifications, such as the closure of a defect, will result in higher pulmonary arterial pressure than expected. Actually, in infants with ventricular septal defect and pulmonary hypertension, a lower preoperative Cp is associated with elevated postoperative pulmonary arterial pressure even when the preoperative Rp was identical (13,23,27), which may allow us to preoperatively identify potential candidates for postoperative targeted therapy for pulmonary hypertension using the combination assessments of Rp and Cp. Pulmonary circulation depended upon Cp rather than Rp according to an increase in pulmonary blood flow despite the constancy in RC time So far, only Rp has been believed to be the universal parameter to determine the indication for corrective surgery in patients with CHD-PH.…”

Section: Resistor-capacitor Coupling In Patients With Congenital Hear...mentioning

confidence: 99%

Comprehensive assessments of pulmonary circulation in children with pulmonary hypertension associated with congenital heart disease

Muneuchi

Ezaki²,

Sugitani³

et al. 2022

Front. Pediatr.

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Pulmonary hypertension associated with congenital heart disease (CHD-PH) encompasses different conditions confounded by the left-to-right shunt, left heart obstruction, ventricular dysfunction, hypoxia due to airway obstruction, dysplasia/hypoplasia of the pulmonary vasculature, pulmonary vascular obstructive disease, and genetic variations of vasoactive mediators. Pulmonary input impedance consists of the pulmonary vascular resistance (Rp) and capacitance (Cp). Rp is calculated as the transpulmonary pressure divided by the pulmonary cardiac output, whereas Cp is calculated as the pulmonary stroke volume divided by the pulmonary arterial pulse pressure. The plots of Rp and Cp demonstrate a unique hyperbolic relationship, namely, the resistor–capacitor coupling curve, which represents the pulmonary vascular condition. The product of Rp and Cp is the exponential pressure decay, which refers to the time constant. Alterations in Cp are more considerable in CHD patients at an early stage of developing pulmonary hypertension or with excessive pulmonary blood flow due to a left-to-right shunt. The importance of Cp has gained attention because recent reports have shown that low Cp potentially reflects poor prognosis in patients with CHD-PH and idiopathic pulmonary hypertension. It is also known that Cp levels decrease in specific populations, such as preterm infants and trisomy 21. Therefore, both Rp and Cp should be individually evaluated in the management of children with CHD-PH who have different disease conditions.

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Section: Resistor-capacitor Coupling In Patients With Congenital Hear...mentioning

confidence: 99%

Comprehensive assessments of pulmonary circulation in children with pulmonary hypertension associated with congenital heart disease

Muneuchi

Ezaki²,

Sugitani³

et al. 2022

Front. Pediatr.

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“…closed incubator (GE Healthcare, USA) with heat set to 37deg C. The compliance of the test lung was calibrated around 0.3 mL/mb +-5%, to be close to the usual lung compliance of ELBW patients. 11 To test the influence of heating devices on humidification, we conducted the experiments with 2 heaterhumidifiers: the MR850 ? with a RT265 ?…”

Section: Phase One (N=12): Bench-test Studymentioning

confidence: 99%

Humidity during high-frequency oscillatory ventilation compared to intermittent positive pressure ventilation in extremely preterm neonates: an in-vitro and in-vivo observational study.

Danan

Tauzin

Jung

et al. 2022

Preprint

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Background: Inappropriate humidification of inspired gas during mechanical ventilation can impair lung development in extremely low birthweight (ELBW) infants. Humidification depends on multiple factors, such as the heater-humidifier device used, type of ventilation, and environmental factors. Few studies have examined inspired gas humidification in these infants, especially during high-frequency oscillatory ventilation (HFOV). Our objective was to compare humidity during HFOV and intermittent positive pressure ventilation (IPPV), in vitro and in vivo. Methods: In-vitro and in-vivo studies used the same ventilator during both HFOV and IPPV. The bench study used a neonatal test lung and 2 heater-humidifiers with their specific circuits; the in-vivo study prospectively included preterm infants born before 28 weeks of gestation. Results: On bench testing, mean absolute (AH) and relative (RH) humidity values were significantly lower during HFOV than IPPV (RH = 79.4% ± 8.1% vs 89.0% ± 6.2%, P<0.001). Regardless of the ventilatory mode, mean relative humidity significantly differed between the 2 heater-humidifiers (89.6% ± 6.7% vs 78.7% ± 6.8%, P=0.003). The in-vivo study included 10 neonates (mean ± SD gestational age: 25.7 ± 0.9 weeks and birth weight: 624.4 ± 96.1 g). Mean relative humidity during HFOV was significantly lower than during IPPV (74.6% ± 5.7% vs 83.0 ± 6.7%, P=0.004). Conclusion: Relative humidity was significantly lower during HFOV than IPPV, both in vitro and in vivo. The type of heater-humidifier also influenced humidification. More systematic measurements of humidity of inspired gas, especially during HFOV, should be considered to optimize humidification and consequently lung protection in ELBW infants.

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“…Prematurity also manifests as multiple extracardiac detriments, including difficulties in postoperative management associated with low body weight (at birth or at initial palliation), respiratory distress syndrome, bronchopulmonary dysplasia, pulmonary hypertension, genetic abnormality, and hepatorenal dysfunction. [1][2][3][4] These issues may persist even long after the initial palliation and may lead to attrition from the Fontan track. [5][6][7] Research has demonstrated that the deleterious effect of younger GA applies not only to premature infants but also to the neonates born at early term.…”

Section: Commentmentioning

confidence: 99%

“…However premature and early-term birth (ie, gestational age [GA] between 37 þ0 and 38 þ6 weeks) are still significant risk factors for increased morbidity and mortality after single-ventricle palliation (SVP). [1][2][3][4][5][6][7][8] Deleterious effect of younger GA may be alleviated by delaying the initial palliation, but the benefits from deferral of initial surgical palliation in terms of higher survival and lower attrition from the Fontan track are still controversial. 3,9 In this study we sought to determine the impact of GA and postmenstrual age (PMA; GA plus postnatal age) at initial palliation on surgical outcomes of SVP, focusing on the risk of interstage mortality (ISM) from each stage of the Fontan track.…”

mentioning

confidence: 99%

Impact of Gestational Age on Surgical Outcomes in Patients With Functionally Single Ventricle

Lee

Park

Kwon

et al. 2020

The Annals of Thoracic Surgery

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Pulmonary arterial resistance and compliance in preterm infants

Cited by 10 publications

References 28 publications

Comprehensive assessments of pulmonary circulation in children with pulmonary hypertension associated with congenital heart disease

Comprehensive assessments of pulmonary circulation in children with pulmonary hypertension associated with congenital heart disease

Humidity during high-frequency oscillatory ventilation compared to intermittent positive pressure ventilation in extremely preterm neonates: an in-vitro and in-vivo observational study.

Impact of Gestational Age on Surgical Outcomes in Patients With Functionally Single Ventricle

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