Regional distribution of blood volume within the preterm infant thorax during synchronised mechanical ventilation

被引:33
作者
Carlisle, Hazel R. [1 ,2 ]
Armstrong, Ruth K. [2 ]
Davis, Peter G. [2 ,3 ,4 ]
Schibler, Andreas [5 ]
Frerichs, Inez [6 ]
Tingay, David G. [2 ,3 ,7 ,8 ]
机构
[1] Canberra Hosp, Dept Neonatol, Ctr Newborn Care, Woden, ACT 2606, Australia
[2] Royal Womens Hosp, Melbourne, Vic, Australia
[3] Murdoch Childrens Res Inst, Melbourne, Vic, Australia
[4] Univ Melbourne, Dept Obstet & Gynaecol, Melbourne, Vic, Australia
[5] Univ Queensland, Mater Childrens Hosp, Brisbane, Qld 4101, Australia
[6] Univ Med Ctr Schleswig Holstein, Dept Anaesthesiol & Intens Care Med, Kiel, Germany
[7] Royal Childrens Hosp, Dept Neonatol, Melbourne, Vic, Australia
[8] Univ Melbourne, Dept Paediat, Melbourne, Vic, Australia
基金
英国医学研究理事会;
关键词
Infant; Preterm; Perfusion; Ventilation; Lung mechanics; Electrical impedance tomography; ELECTRICAL-IMPEDANCE TOMOGRAPHY; LUNG VENTILATION; PULMONARY PERFUSION; NEONATAL LUNGS; GAS-EXCHANGE; BORN INFANTS; EIT IMAGES; POSITION; PRONE; REPRODUCIBILITY;
D O I
10.1007/s00134-010-2049-4
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
Perfusion in healthy adults is gravity-dependent. Little is known about lung perfusion in the preterm infant. The aim of this study was to describe the regional distribution of blood volume within the thorax in preterm infants receiving synchronised volume-targeted mechanical ventilation (SIPPV + TTV) and to compare this to regional distribution of tidal ventilation using electrical impedance tomography (EIT). Stable supine ventilated preterm infants (< 32-week gestation) were studied. Three sets of artefact-free 30-s EIT recordings of the right hemithorax were filtered in the cardiac and respiratory frequency domains to differentiate impedance change due to blood (Delta Z (c)) and gas volume (Delta Z (v)). The distribution of Delta Z (c) and Delta Z (v) in the anterior-to-posterior regions of the right chest were compared. Infants were subdivided by age (a parts per thousand currency sign7, > 7 days) and oxygen requirement. A total of 5,471 beats were analysed from 26 infants (78 recordings); mean (standard deviation (SD)) gestational age was 26 (2) weeks and mean (SD) postnatal age was 9 (10) days. The median (interquartile range) Delta Z (c) in the anterior half of the hemithorax was 1.41-fold (0.88-2.11) greater than that in the posterior half. The geometric centre of Delta Z (c) was located at 46.7% of the anterior-posterior thoracic distance, compared to a more centrally located Delta Z (v) (49.6%; p < 0.0001). The Delta Z (v)/Delta Z (c) ratio was 1.7 in the anterior third of the chest and 2.2 in the posterior (p < 0.0001). The area under the curve (AUC) analysis showed that Delta Z (c) was more evenly distributed in infants > 7 days of age and not influenced by oxygen requirement. There are gravity dependent differences in the distribution of blood volume and ventilation in the ventilated preterm chest.
引用
收藏
页码:2101 / 2108
页数:8
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