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Perinatal Cardiopulmonary interactions Dr David Tingay Neonatologist, Royal Children’s Hospital, Melbourne, Australia Senior Research Fellow, Murdoch Children’s Research Institute & University of Melbourne

Influence of MV on pulmonary blood flow at birth

Polglase et  al  JAP  2009    

Influence of MV on ductal blood flow at birth R-­‐L component  to  Shunt  

Pure L-­‐R  Shunt  

Polglase et  al  JAP  2009    

Cardiovascular effects  of  Paw   during  HFOV   Osborn and Evans J Peds 2003 •  45 preterm infants (<29 weeks) randomised to HFOV or CMV •  Paw + 1.5 to 3cm H2O higher in HFOV group •  No difference in SVC flow or RV output at 3, 10 and 24 hours

Cambonie et al Acta Paediatr 2003 •  •  •  • 

32 infants, <32 weeks, randomised to HFOV or CMV Paw +2 cm H2O higher in HFOV group No change in LV output at 12h, 27h, 48h Also, no change in •  PA pressure •  LV systolic function (LV fractional shortening and VCFS corrected for ESWS)

No change  in:   •  Duct  size   •  Shunt  (21%  of  Cme   in  R-­‐L  shunt)   •  R-­‐L  DA  VTI   •  L-­‐R  DA  VTI  

Anterior 1/3rd     Middle  1/3rd     Posterior  1/3rd    

Term RDS + acute PHT iNO and HFOV

Kinsella et  al  J  Peds  1997   50%  of  all  infants  receiving  iNO  in  Australia  and  NZ  1996-­‐2003  also  received  HFV   Tingay  et  al  JPCH  2007  

Maintaining a ductus Congenital AVM

Patel et  al  J  Perinat  2007  

Summary •  Early life is associated with complex changes in the cardiac and pulmonary systems •  Inappropriate transition of the circulatory system may have detrimental longterm effects •  Respiratory strategies have the potential to influence circulatory function in early life •  The clinical significance remains unknown

Pulmonary artery pressure (mmHg)

Rela:onship of  airway  pressure  and  PAP  in  an   infant  on  HFOV     90


50 Inflation Deflation

30 10








MAP (cm H2O)

Patel et al 2005

•  Increased PVR/PAP  with  Paw   •  Reduced  PVR  aXer  lung  volume  recruitment   •  U-­‐shaped  relaConship  of  PVR  and  Paw  

Presentation 41 - Tingay  
Presentation 41 - Tingay  

Presentation 41 - Tingay