High-CPAP Does Not Impede Cardiovascular Changes at Birth in Preterm Sheep.

Martherus, Tessa; Crossley, Kelly J; Rodgers, Karyn A; Dekker, Janneke; Demel, Anja; Moxham, Alison M; Zahra, Valerie A; Polglase, Graeme R; Roberts, Calum T; Te Pas, Arjan B; Hooper, Stuart B

Martherus, Tessa; Crossley, Kelly J; Rodgers, Karyn A; Dekker, Janneke; Demel, Anja; Moxham, Alison M; Zahra, Valerie A; Polglase, Graeme R; Roberts, Calum T; Te Pas, Arjan B; Hooper, Stuart B.

Afiliación

Martherus T; Division of Neonatology, Department of Pediatrics, Leiden University Medical Center, Leiden, Netherlands.
Crossley KJ; The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, VIC, Australia.
Rodgers KA; The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, VIC, Australia.
Dekker J; Division of Neonatology, Department of Pediatrics, Leiden University Medical Center, Leiden, Netherlands.
Demel A; The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, VIC, Australia.
Moxham AM; The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, VIC, Australia.
Zahra VA; The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, VIC, Australia.
Polglase GR; The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, VIC, Australia.
Roberts CT; The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, VIC, Australia.
Te Pas AB; Department of Obstetrics and Gynecology, Monash University, Melbourne, VIC, Australia.
Hooper SB; The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, VIC, Australia.

Front Pediatr ; 8: 584138, 2020.

Article en En | MEDLINE | ID: mdl-33553064

ABSTRACT

ABSTRACT

Objective:

Continuous positive airway pressures (CPAP) used to assist preterm infants at birth are limited to 4-8 cmH2O due to concerns that high-CPAP may cause pulmonary overexpansion and adversely affect the cardiovascular system. We investigated the effects of high-CPAP on pulmonary (PBF) and cerebral (CBF) blood flows and jugular vein pressure (JVP) after birth in preterm lambs.

Methods:

Preterm lambs instrumented with flow probes and catheters were delivered at 133/146 days gestation. Lambs received low-CPAP (LCPAP 5 cmH2O), high-CPAP (HCPAP 15 cmH2O) or dynamic HCPAP (15 decreasing to 8 cmH2O at ~2 cmH2O/min) for up to 30 min after birth.

Results:

Mean PBF was lower in the LCPAP [median (Q1-Q3); 202 (48-277) mL/min, p = 0.002] compared to HCPAP [315 (221-365) mL/min] and dynamic HCPAP [327 (269-376) mL/min] lambs. CBF was similar in LCPAP [65 (37-78) mL/min], HCPAP [73 (41-106) mL/min], and dynamic HCPAP [66 (52-81) mL/min, p = 0.174] lambs. JVP was similar at CPAPs of 5 [8.0 (5.1-12.4) mmHg], 8 [9.4 (5.3-13.4) mmHg], and 15 cmH2O [8.6 (6.9-10.5) mmHg, p = 0.909]. Heart rate was lower in the LCPAP [134 (101-174) bpm; p = 0.028] compared to the HCPAP [173 (139-205)] and dynamic HCPAP [188 (161-207) bpm] groups. Ventilation or additional caffeine was required in 5/6 LCPAP, 1/6 HCPAP, and 5/7 dynamic HCPAP lambs (p = 0.082), whereas 3/6 LCPAP, but no HCPAP lambs required intubation (p = 0.041), and 1/6 LCPAP, but no HCPAP lambs developed a pneumothorax (p = 0.632).