The Effects of Intermittent Positive Pressure Ventilation on Cerebral Arterial and Venous Blood Velocities in the Newborn Infant
F. COWAN
Department of Neonatal Paediatrics, Ullevål Hospital, Oslo, and the Institute of Physiology, University of Oslo, Norway
Search for more papers by this authorCorresponding Author
M. THORESEN
Department of Neonatal Paediatrics, Ullevål Hospital, Oslo, and the Institute of Physiology, University of Oslo, Norway
(M.T.) Karolinska Institute The Nobel Institute for Neurophysiology Box 60400 S- 104 01 Stockholm SwedenSearch for more papers by this authorF. COWAN
Department of Neonatal Paediatrics, Ullevål Hospital, Oslo, and the Institute of Physiology, University of Oslo, Norway
Search for more papers by this authorCorresponding Author
M. THORESEN
Department of Neonatal Paediatrics, Ullevål Hospital, Oslo, and the Institute of Physiology, University of Oslo, Norway
(M.T.) Karolinska Institute The Nobel Institute for Neurophysiology Box 60400 S- 104 01 Stockholm SwedenSearch for more papers by this authorAbstract
ABSTRACT. Cerebral arterial and venous blood velocities were measured using pulsed Doppler ultrasound in 25 newborn infants requiring intermittant positive pressure ventilation (IPPV). The aim was to investigate whether these velocities altered in relation to the peak inflation pressure (PIP) used. Continous recordings were made on the superior sagittal sinus and an intracranial artery both at the clinically prescribed PIP, and while this was altered in steps. A majority of the infants had, at some stage of their illness, variations in their venous and arterial velocities in phase with IPPV and related to the PIP used. These variations could be reduced by lowering the PIP. This was done in 5 infants whilst we were still able to maintain adequate ventilation.
REFERENCES
- 1 Wise RA, Robotham JL, Summer WR. Effects of spontaneous ventilation on the circulation. Lung 1981; 159: 175–86.
- 2 Morgan BC, Martin WE, Hornbein TF, Crawford EW, Guntheroth WG. Hemodynamic effects of intermittent positive pressure respiration. Anesthesiology 1966; 27: 584–90.
- 3 Scharf SM, Brown R, Saunders N, Green LH. Hemodynamic effects of positive-pressure inflation. J Appl Physiol 1980; 49: 124–31.
- 4 Morgan BC, Crawford EW, Guntheroth WG. The hemodynamic effects of changes in blood volume during intermittent positive-pressure ventilation. Anesthesiology 1969; 30: 297–305.
- 5 Greenough A, Morley CJ. Oesophageal pressure measurements in ventilated preterm babies. Arch Dis Child 1982; 57: 851–55.
- 6
Lafia DJ,
Chase HF,
Kilmore MA.
Effects of respiratory obstruction during craniotomy.
J Neurosurg
1969; 17: 877–86.
10.3171/jns.1960.17.5.0877 Google Scholar
- 7 Löfgren J. Airway pressure—neurosurgical aspects. Anesthesiology 1976; 45: 269–72.
- 8 Leahy FAN, Durand M, Cates D, Chernick V. Cranial blood volume changes during mechanical ventilation and spontaneous breathing in newborn infants. J Pediatr 1982; 101: 984–87.
- 9 Milligan DWA. Positive pressure ventilation and cranial volume in newborn infants. Arch Dis Child 1981; 56: 331–35.
- 10 Huseby JS, Pavlin EG, Butler J. Effect of positive end-expiratory pressure on intracranial pressure in dogs. J Appl Physiol 1978; 44: 25–27.
- 11 Luce JM, Huseby JS, Kirk W, Butler J. Mechanism by which positive end-expiratory pressure increases cerebrospinal fluid pressure in dogs. J Appl Physiol 1982; 52: 231–35.
- 12 Vert P, Monin P, Sibout M. Intracranial venous pressure in newborns: Variations in physiologic state and in neurologic and respiratory disorders. In: L Stern, B Friis-Hansen, P Kildeberg, eds. Intensive care in the newborn. Lancaster , England : MTD Press, 1979; 185–96.
- 13 Hatteland K, Eriksen M. A heterodyne ultrasound blood velocity meter. Med Biol Eng Comput 1981; 19: 91–96.
- 14 Wille S. A computer system for on-line decoding of ultrasonic Doppler signals from blood flow measurement. Ultrasonics 1977; 15: 226–30.
- 15 Lundell BPW, Lindstrom DP, Arnold TG. Neonatal cerebral blood flow velocity I. Acta Paediatr Scand 1984; 73: 810–15.
- 16 Rosenberg AA, Narayanan V, Douglas Jones M. Comparison of anterior cerebral artery blood flow velocity and cerebral blood flow during hypoxia. Pediatr Res 1985; 19: 67–70.
- 17 Guldvog I, Kjæernes M, Thoresen M, Walløe. E Blood flow in arteries determined transcutaneously by an ultrasonic doppler velocitymeter as compared to electromagnetic measurements on the exposed vessels. Acta Physiol Scand 1980; 109: 211–16.
- 18 Bucci G, Scalamandre A, Savignoni PG, Mendicini M, Picene-Bucci S, Piccinato L. The systemic systolic blood pressure of newborns with low weight. Acta Paediatr Scand 1972; Suppl 229.
- 19 Whitelaw AGL, Wright BM. A pneumatic applanimeter for intracranial pressure measurements. J Physiol 1983; 336: 3P–4P.
- 20 Cabal LA, Devaskar U, Siassi B, Hodgman JE, Emmanouildes G. Cardiogenic shock associated with perinatal asphyxia in preterm infants. J Pediatr 1980; 96: 705–10.
- 21 Boros SJ, Matalon SV, Ewald R, Leonard AS, Hunt CE. The effect of independent variations in inspiratory-expiratory ratio and end expiratory pressure during mechanical ventilation in hyaline membrane disease: The significance of mean airway pressure. J Pediatr 1977; 91: 794–98.
- 22 Greenough A, Morley C, Davis J. Interaction of spontaneous respiration with artificial ventilation in preterm babies. I Pediatr 1983; 103: 769–73.
- 23 Morgan BC, Crawford EW, Winterscheid LC, Gunther WG. Circulatory effects of intermittent positive pressure ventilation. Northwest Med 1968; 67: 149–52.
- 24 Santamore WP, Heckman JL, Bove AA. Cardiovascular changes from expiration to inspiration during IPPV. Am J Physiol 1983; 245: H307–12.
- 25 Cassidy SS, Gaffney FA, Johnson RL. A perspective on PEEP. N Engl J Med 1981; 304: 421–22.
- 26 Colgan FJ, Barrow RE, Fanning GL. Constant positive-pressure breathing and cardiorespiratory function. Anesthesiology 1971; 34: 145–51.
- 27 Aidinis SJ, Lafferty J, Shapiro HM. Intracranial responses to PEEP. Anesthesiology 1976; 45: 275–86.
- 28 Lemos RA, Tomasovic JJ. Effects of positive pressure ventilation on cerebral blood flow in the newborn infant. Clin Perinatol 1978; 5: 395–409.
- 29 Cowan F, Eriksen M, Thoresen M. An evaluation of the plethysmographic method of measuring cranial blood flow in the new-born infant. J Physiol 1983; 335: 41–50.
- 30 Hill A, Perlman JM, Volpe JJ. Relationship of pneumothorax to occurrence of intraventricular hemorrhage in the premature newborn. Pediatrics 1982; 69: 144–149.
- 31 Lipscomb AP, Reynolds EOR, Blackwell RJ, et al. Pneumothorax and cerebral haemorrhage in preterm infants. Lancet 1981; 1: 414–16.
- 32 Garcia-Prats JA, Procianoy RS, Adams JM, Rudolph AJ. The hyaline membrane disease-intraventricular hemorrhage relationship in the very low birth weight infant: perinatal aspects. Acta Paediatr Scand 1982; 71: 79–84.
- 33 Goldberg RN, Chung D, Goldman SL, Bancalari E. The association of rapid volume expansion and intraventricular hemorrhage in the preterm infant. J Pediatr 1980; 96: 1060–63.
- 34 Dykes FD, Lazzara A, Ahmann P, Blumenstein B, Schwartz J, Brann AW. Intraventricular hemorrhage: A prospective evaluation of etiopathogenesis. Pediatrics 1980; 66: 42–49.
- 35 Perlman JM, McMenamin JB, Volpe JJ. Fluctuating cerebral blood-flow velocity in respiratory-distress syndrome. N Engl J Med 1981; 319: 204–09.
- 36 Perlman JM, Goodman SB, Kreusser KL, Volpe JJ. Reduction in intraventricular hemorrhage by elimination of fluctuating cerebral blood-flow velocity in preterm infants with respiratory distress syndrome. N Engl J Med 1985; 321: 1353–57.