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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Hemodynamic changes during weaning from nasal continuous positive airway pressure
Pediatrics, Volume 122, No. 5, Year 2008
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Description
BACKGROUND. Nasal continuous positive airway pressure is frequently used to support preterm infants with respiratory distress syndrome. Little is known about the hemodynamic changes that occur, particularly during the weaning phase when lung compliance has improved and most of the airway pressure can be transmitted to the heart and major blood vessels. Methods. We conducted a prospective study on preterm infants (gestational age ≤32 weeks) with resolving respiratory distress syndrome, who were receiving nasal continuous positive airway pressure of 5 cm H2O and 21% oxygen. While cycling nasal continuous positive airway pressure, we performed 2-dimensional M-mode and pulsed Doppler echocardiography on all infants during nasal continuous positive airway pressure and 1 hour after being off nasal continuous positive airway pressure. Results. A total of 25 preterm infant were studied. The use of nasal continuous positive airway pressure significantly decreased right ventricular output (320 ± 22. 7 vs 410. 5 ± 44. 1 mL/kg per min);right ventricular end diastolic diameter (6 ± 0. 7 vs 6. 4 ± 0. 4 mm), left ventricular end diastolic diameter (11. 6 ± 0. 9 vs 13. 6 ± 0. 7 mm), left ventricular end systolic diameter (7. 1 ± 0. 6 vs 8. 3 ± 0. 4 mm), left atrial diameter (6. 3 ± 0. 5 vs 8 ± 0. 5 mm), aortic root diameter (6. 4 ± 0. 3 vs 6. 6 ± 0. 4 mm), superior vena cava flow (70. 2 ± 8. 5 vs 91. 1 ± 4 mL/kg per minute), and pulmonary maximum velocity (0. 6 ± 0. 1 vs 0. 7 ± 0. 1 m/seconds). It significantly increased mean inferior vena cava diameter (4. 3 ± 0. 5 vs 3. 5 ± 0. 6 mm), whereas nasal continuous positive airway pressure did not influence left ventricular output, aortic maximum velocity, fractional shortening, heart rate, or mean arterial blood pressure. Changes associated with nasal continuous positive airway pressure were similar in infants with (n = 8) and without (n = 17) patent ductus arteriosus. Conclusions. In infants with resolving respiratory distress syndrome, nasal continuous positive airway pressure can impede systemic and pulmonary venous return, but it does not compromise systemic arterial pressure or heart rate. It is not clear whether the degree of these hemodynamic changes can affect the success of weaning off nasal continuous positive airway pressure. Copyright © 2008 by the American Academy of Pediatrics.
Authors & Co-Authors
Abdel-Hady, H. El Sayed
Egypt, Mansoura
Mansoura University Children's Hospital
Matter, Mohamed K.
Egypt, Mansoura
Mansoura University Children's Hospital
Hammad, Ayman Mohammad
Egypt, Mansoura
Mansoura University Children's Hospital
El-Refaey, Ahmed M.
Egypt, Mansoura
Mansoura University Children's Hospital
Aly, Hany Z.
United States, Washington, D.c.
The George Washington University
Statistics
Citations: 41
Authors: 5
Affiliations: 2
Identifiers
Doi:
10.1542/peds.2008-1193
ISSN:
00314005
e-ISSN:
10984275
Research Areas
Maternal And Child Health
Noncommunicable Diseases
Study Design
Cohort Study