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Physiologic factors affecting pulmonary artery pressure in infants with persistent pulmonary hypertension

G J Peckham, W W Fox

    The Journal of Pediatrics
    |December 1, 1978
    PubMed

    Insights

    Severe persistent pulmonary hypertension in newborns can be effectively managed by mechanical ventilation to decrease Paco2. This intervention significantly reduces pulmonary artery pressure, leading to resolution of hypertension in survivors.

    Area of Science:

    • Neonatal Medicine
    • Pediatric Cardiology
    • Respiratory Physiology

    Background:

    • Persistent pulmonary hypertension of the newborn (PPHN) is a critical condition characterized by elevated pulmonary artery pressure.
    • Continuous monitoring of pulmonary artery pressure is essential for managing PPHN.

    Purpose of the Study:

    • To investigate the effect of mechanical ventilation and controlled hyperventilation on pulmonary artery pressure in infants with severe PPHN.
    • To analyze physiological changes associated with decreased pulmonary artery pressure.

    Main Methods:

    • Indwelling pulmonary artery catheters for continuous pressure monitoring in ten infants with severe PPHN.
    • Mechanical ventilation with controlled hyperventilation to decrease Paco2 levels.
    • Comparison of physiological measurements over an eight-hour period.

    Main Results:

    • Pulmonary artery pressure was highly labile, with fluctuations up to 50 mm Hg.
    • Decreasing Paco2 from 48.9 to 28.3 mm Hg via hyperventilation reduced mean pulmonary artery pressure by 36 mm Hg (P < 0.001).
    • Mean AadeltaO2 decreased by 146 mm Hg (P < 0.001) with the reduction in pulmonary artery pressure.

    Conclusions:

    • Mechanical ventilation targeting a Paco2 range of 25-30 mm Hg can effectively lower pulmonary artery pressure in neonates with PPHN.
    • This approach facilitates the gradual resolution of pulmonary hypertension in survivors.
    • Controlled hyperventilation is a viable strategy for managing severe PPHN.

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