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Published online October 31, 2008
PEDIATRICS Vol. 122 No. 5 November 2008, pp. e1086-e1090 (doi:10.1542/peds.2008-1193)
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ARTICLE

Hemodynamic Changes During Weaning From Nasal Continuous Positive Airway Pressure

Hesham Abdel-Hady, MDa, Mohamed Matter, MDb, Ayman Hammad, MDa, Ahmed El-Refaay, MDa, Hany Aly, MDc

a Neonatal Care Unit
b Pediatric Cardiology Unit, Mansoura University Children's Hospital, Egypt
c Department of Neonatology, The George Washington University and the Children's National Medical Center, Washington, DC

BACKGROUND. Nasal continuous positive airway pressure is frequently used to support preterm infants with respiratory distress syndrome. Little is known about the hemodynamic changes that occur, particularly during the weaning phase when lung compliance has improved and most of the airway pressure can be transmitted to the heart and major blood vessels.

METHODS. We conducted a prospective study on preterm infants (gestational age ≤32 weeks) with resolving respiratory distress syndrome, who were receiving nasal continuous positive airway pressure of 5 cm H2O and 21% oxygen. While cycling nasal continuous positive airway pressure, we performed 2-dimensional M-mode and pulsed Doppler echocardiography on all infants during nasal continuous positive airway pressure and 1 hour after being off nasal continuous positive airway pressure.

RESULTS. A total of 25 preterm infant were studied. The use of nasal continuous positive airway pressure significantly decreased right ventricular output (320 ± 22.7 vs 410.5 ± 44.1 mL/kg per min); right ventricular end diastolic diameter (6 ± 0.7 vs 6.4 ± 0.4 mm), left ventricular end diastolic diameter (11.6 ± 0.9 vs 13.6 ± 0.7 mm), left ventricular end systolic diameter (7.1 ± 0.6 vs 8.3 ± 0.4 mm), left atrial diameter (6.3 ± 0.5 vs 8 ± 0.5 mm), aortic root diameter (6.4 ± 0.3 vs 6.6 ± 0.4 mm), superior vena cava flow (70.2 ± 8.5 vs 91.1 ± 4 mL/kg per minute), and pulmonary maximum velocity (0.6 ± 0.1 vs 0.7 ± 0.1 m/seconds). It significantly increased mean inferior vena cava diameter (4.3 ± 0.5 vs 3.5 ± 0.6 mm), whereas nasal continuous positive airway pressure did not influence left ventricular output, aortic maximum velocity, fractional shortening, heart rate, or mean arterial blood pressure. Changes associated with nasal continuous positive airway pressure were similar in infants with (n = 8) and without (n = 17) patent ductus arteriosus.

CONCLUSIONS. In infants with resolving respiratory distress syndrome, nasal continuous positive airway pressure can impede systemic and pulmonary venous return, but it does not compromise systemic arterial pressure or heart rate. It is not clear whether the degree of these hemodynamic changes can affect the success of weaning off nasal continuous positive airway pressure.

Key Words: CPAP • cardiac output • preterm infants • echocardiography

Abbreviations: nCPAP—nasal continuous positive airway pressure • RDS—respiratory distress syndrome • CO—cardiac output • PDA—patent ductus arteriosus • SPO2—transcutaneous oxygen saturation • LVDD—left ventricular cavity dimensions at end-diastole • RVO—right ventricular output • LVO—left ventricular output • SVC—superior vena cava • IVCD—mean inferior vena cava diameter

Accepted Jul 24, 2008.


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