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Ventilator-induced pulse pressure variation in neonates.

Linda Heskamp1, Benno Lansdorp2, Jeroen Hopman3

  • 1Department of Neonatology, Radboudum Amalia Children's Hospital, Nijmegen, The Netherlands MIRA-Institute for Biomedical Technology and of Technical Medicine, of the Faculty of Science and Technology, University of Twente, Enschede, The Netherlands.

Physiological Reports
|February 25, 2016
PubMed
Summary

Pulse pressure variation (PPV) in neonates on ventilation is linked to cardiopulmonary interactions. However, physiological aliasing limits PPV

Keywords:
Arterial blood pressure variabilityfluid responsivenessneonatal hemodynamicsneonatespulse pressure variation

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Area of Science:

  • Neonatal physiology
  • Cardiopulmonary interactions
  • Mechanical ventilation

Background:

  • Arterial pressure variations, including pulse pressure variation (PPV), are observed in neonates undergoing positive pressure ventilation.
  • The frequency of PPV may not consistently align with the respiratory rate, potentially due to the low respiratory rate/heart rate ratio.
  • Cardiopulmonary interaction is hypothesized to cause PPV, but the mismatch suggests other influencing factors.

Purpose of the Study:

  • To investigate the relationship between pulse pressure variation (PPV) and ventilation in neonates.
  • To explore the influence of different ventilation modes (SIMV and HFV) on PPV.
  • To determine if PPV can reliably predict fluid responsiveness in this population.

Main Methods:

  • A prospective observational cross-sectional study was conducted in a neonatal intensive care unit.
  • Arterial blood pressure was continuously monitored in neonates on synchronized intermittent mandatory ventilation (SIMV) and high-frequency ventilation (HFV).
  • Respiratory signals were obtained from CO2 waveforms (SIMV) and thorax impedance (HFV), with correlation and coherence analysis performed against pulse pressure.

Main Results:

  • Significant correlation and coherence were found between respiratory signals and pulse pressure in both SIMV and HFV groups.
  • Correlation coefficients were -0.64 ± 0.18 for SIMV and 0.55 ± 0.16 for HFV.
  • Coherence at respiratory frequency was 0.95 ± 0.11 for SIMV and 0.76 ± 0.4 for HFV.

Conclusions:

  • Arterial pressure variations in neonates on SIMV or HFV are indeed related to cardiopulmonary interactions.
  • Physiological aliasing significantly impacts the PPV measurement in neonates.
  • Pulse pressure variation is unlikely to be a reliable predictor of fluid responsiveness in neonates due to these physiological limitations.