The effects of closed tracheal suctioning plus volume guarantee on cerebral hemodynamics

Kaiser, Jeffrey R.; Gauss, C. Heath; Williams, David

doi:10.1038/jp.2011.8

Cited by 12 publications

(14 citation statements)

References 31 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…We observed a rapid reduction in carotid arterial PI and increased carotid blood flow and P BCA during and immediately after open ETT suction, consistent with increased cerebral blood flow and pressure during ETT suction (18,19), irrespective of prenatal treatment. High cerebral blood flow velocity has been demonstrated as a sensitive predictor of neonatal mortality and poor neurological outcome at 12 mo of age (29,30); thus, the cerebral circulatory consequences of open ETT suction may result in brain injury.…”

Section: Chorioamnionitis Alters Hemodynamicsmentioning

confidence: 54%

“…Endotracheal tube (ETT) suction is one of the most common interventions performed during respiratory support of preterm infants and is known to alter lung mechanics and systemic hemodynamics (3,(16)(17)(18)(19)(20). However, to our knowledge, the impact of prior exposure to intrauterine inflammation on these consequences is unknown.…”

mentioning

confidence: 98%

“…High cerebral blood flow velocity has been demonstrated as a sensitive predictor of neonatal mortality and poor neurological outcome at 12 mo of age (29,30); thus, the cerebral circulatory consequences of open ETT suction may result in brain injury. ETT suctioning is most frequently performed during the first 72 h after delivery, with a single infant undergoing as many as six suction procedures during this period (19). Regular and rapid fluctuations in cerebral hemodynamics combined with impaired cerebral autoregulation, which is a common characteristic of preterm neonates, particularly those born weighing <1,500 g (31), may contribute to the increased incidence of poor neurological outcome and cerebral injury such as intraventricular hemorrhage in the preterm population (32)(33)(34).…”

Section: Chorioamnionitis Alters Hemodynamicsmentioning

confidence: 99%

See 2 more Smart Citations

Intrauterine inflammation alters cardiopulmonary but not cerebral hemodynamics during open endotracheal tube suction in preterm lambs

et al. 2013

View full text Add to dashboard Cite

Background: Intrauterine inflammation adversely affects cardiopulmonary, systemic, and cerebral hemodynamics in preterm neonates, but its impact on responses to endotracheal tube (ETT) suction, known to affect hemodynamics, is unknown. We hypothesized that intrauterine inflammation would alter the cardiopulmonary and cerebral hemodynamic response to open ETT suction in preterm lambs. Methods: Chronically instrumented fetuses received intraamniotic lipopolysaccharide (LPS; to induce intrauterine inflammation) or saline at 118 d of gestation (term ~147 d). At 125 d of gestation, lambs were delivered and mechanically ventilated. Open ETT suction was performed 30 min after delivery. Pulmonary and cerebral arterial pressures and flows were recorded continuously. results: Intrauterine inflammation reduced pulmonary blood flow (PBF) and increased pulmonary vascular resistance (PVR) after preterm birth. PBF and left-ventricular output (LVO) increased during and immediately after ETT suction in both groups, but the values were higher in LPS-exposed lambs. Preductal oxygenation significantly decreased during ETT suction but to a greater extent in LPS-exposed lambs. Cerebral blood flow and systemic arterial pressure were increased by open ETT suction similarly in the two groups. conclusion: Intrauterine inflammation exacerbates the neonatal hemodynamic response to open ETT suction.

show abstract

Section: Chorioamnionitis Alters Hemodynamicsmentioning

confidence: 54%

mentioning

confidence: 98%

Section: Chorioamnionitis Alters Hemodynamicsmentioning

confidence: 99%

See 1 more Smart Citation

Intrauterine inflammation alters cardiopulmonary but not cerebral hemodynamics during open endotracheal tube suction in preterm lambs

et al. 2013

View full text Add to dashboard Cite

show abstract

“…3,15,[25][26][27] In the prior studies, cerebral autoregulation was found to be influenced by hypercapnia and associated with severe IVH. In addition, changes to cerebral hemodynamics occurred during surfactant administration and tracheal suctioning.…”

Section: Introductionmentioning

confidence: 99%

The Ontogeny of Cerebrovascular Pressure Autoregulation in Premature Infants

Rhee

Fraser²,

Kibler

et al. 2016

Acta Neurochirurgica Supplement

View full text Add to dashboard Cite

Objective-To quantify cerebrovascular autoregulation as a function of gestational age (GA) and across the phases of the cardiac cycle.Study design-The present study is a hypothesis-generating re-analysis of previously published data. Premature infants (n=179), with a GA range of 23 to 33 weeks were monitored with umbilical artery catheters and transcranial Doppler insonation of the middle cerebral artery for 1-hour sessions over the first week of life. Autoregulation was quantified by three methods, as a moving correlation coefficient between: 1) systolic arterial blood pressure (ABP) and systolic cerebral blood flow (CBF) velocity (Sx); 2) mean ABP and mean CBF velocity (Mx); and 3) diastolic ABP and diastolic CBF velocity (Dx). Comparisons of individual and cohort cerebrovascular pressure autoregulation were made across GA for each aspect of the cardiac cycle.Results-Systolic, mean and diastolic ABP increased with GA (r=0.3, 0.4, and 0.4; p<0.0001). Systolic CBF velocity was pressure-passive in infants with the lowest GA, and Sx decreased with advancing GA (r=−0.3; p<0.001), indicating increased capacity for cerebral autoregulation during systole during development. By contrast, Dx was elevated, indicating dysautoregulation, in all subjects and showed minimal change with advancing GA (r=−0.06; p=0.05). Multivariate analysis confirmed that both GA (p<0.001) and "effective cerebral perfusion pressure" (ABP minus critical closing pressure; p<0.01) were associated with Sx. HHS Public Access Author Manuscript Author ManuscriptAuthor Manuscript Author ManuscriptConclusion-Premature infants have low and usually pressure-passive diastolic CBF velocity. By contrast, the regulation of systolic CBF velocity by pressure autoregulation developed in this cohort between 23 and 33 weeks GA. Elevated effective cerebral perfusion pressure derived from the critical closing pressure was associated with dysautoregulation.

show abstract

“…[27][28][29][30][31]. Approval was obtained by the University of Arkansas for Medical Sciences Institutional Review Board, and informed parental consent was obtained before enrollment.…”

Section: Methodsmentioning

confidence: 99%

Ontogeny of cerebrovascular critical closing pressure

Rhee

Fraser²,

Kibler

et al. 2015

Pediatr Res

View full text Add to dashboard Cite

Background: Premature infants are at risk of vascular neurologic insults. Hypotension and hypertension are considered injurious, but neither condition is defined with consensus. Cerebrovascular critical closing pressure (CrCP) is the arterial blood pressure (ABP) at which cerebral blood flow (CBF) ceases. CrCP may serve to define subject-specific low or high ABP. Our objective was to determine the ontogeny of CrCP. Methods: Premature infants (n = 179) with gestational age (GA) from 23-31 wk had recordings of ABP and middle cerebral artery flow velocity twice daily for 3 d and then daily for the duration of the first week of life. All infants received mechanical ventilation. CrCP was calculated using an impedance-model derivation with Doppler-based estimations of cerebrovascular resistance and compliance. The association between GA and CrCP was determined in a multivariate analysis. results: The median (interquartile range) CrCP for the cohort was 22 mm Hg (19-25 mm Hg). CrCP increased significantly with GA (r = 0.6; slope = 1.4 mm Hg/wk gestation), an association that persisted with multivariate analysis (P < 0.0001). conclusion: CrCP increased significantly from 23 to 31 wk gestation. The low CrCP observed in very premature infants may explain their ability to tolerate low ABP without global cerebral infarct or hemorrhage. c erebrovascular critical closing pressure (CrCP) is the arterial blood pressure (ABP) at which blood flow to the brain ceases due to vascular collapse. Also referred to as collapsing pressure, CrCP can be easily and noninvasively monitored at the bedside using Doppler ultrasound and ABP measurements (1). CrCP is posited to be the sum of vascular wall tension and intracranial pressure (2). CrCP can be conceptualized as a factor for the normalization of ABP to an "effective cerebral perfusion pressure" or "closing margin" (3,4). The "effective cerebral perfusion" or "closing margin" (ABP-CrCP) can be determined for any phase of the cardiac cycle by subtracting the CrCP from systolic, mean, or diastolic ABP.Limited data sets report CrCPs in term and preterm newborns ranging from 24 to 33 mm Hg, which is similar to reported values in mature subjects (5,6). Low ABP in premature infants results in a closing margin that is strikingly low (Figure 1). Premature infants are commonly treated for low values of blood pressure based on mean ABP thresholds related to their gestational age (GA) (7-9), and these thresholds are within the range of published CrCP values (5,6). Moreover, during postnatal transition, a period of time often characterized by shock, premature infants can have CBF limited to the systolic phase of the cardiac cycle (10).Disparity in the definition of hypotension and treatment thresholds for low ABP are likely attributable to a lack of outcome data in premature infants demonstrating a benefit for treating low ABP (11). We propose that an important confounding factor may be the low closing margin relative to the range of CrCP in this population. For example, a difference of 10 mm Hg Cr...

show abstract

The effects of closed tracheal suctioning plus volume guarantee on cerebral hemodynamics

Cited by 12 publications

References 31 publications

Intrauterine inflammation alters cardiopulmonary but not cerebral hemodynamics during open endotracheal tube suction in preterm lambs

Intrauterine inflammation alters cardiopulmonary but not cerebral hemodynamics during open endotracheal tube suction in preterm lambs

The Ontogeny of Cerebrovascular Pressure Autoregulation in Premature Infants

Ontogeny of cerebrovascular critical closing pressure

Contact Info

Product

Resources

About