Page 1

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

70

50 Inflation Deflation

30 10

12

14

16

18

20

22

24

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

Read more
Read more
Similar to
Popular now
Just for you