title: Ventilator-induced pulse pressure variation in neonates.
abstract: During positive pressure ventilation, arterial pressure variations, like the pulse pressure variation (PPV), are observed in neonates. However, the frequency of the PPV does not always correspond with the respiratory rate. It is hypothesized that PPV is caused by cardiopulmonary interaction, but that this mismatch is related to the low respiratory rate/heart rate ratio. Therefore, the goal of this study is to investigate the relation between PPV and ventilation in neonates. A prospective observational cross-sectional study was carried out in a third-level neonatal intensive care unit in a university hospital. Neonates on synchronized intermittent mandatory ventilation (SIMV) or high-frequency ventilation (HFV) participated in the study. The arterial blood pressure was continuously monitored in 20 neonates on SIMV and 10 neonates on HFV. In neonates on SIMV the CO2 waveform and neonates on HFV the thorax impedance waveform were continuously monitored and defined as the respiratory signal. Correlation and coherence between the respiratory signal and pulse pressure were determined. The correlation between the respiratory signal and pulse pressure was -0.64 ± 0.18 and 0.55 ± 0.16 and coherence at the respiratory frequency was 0.95 ± 0.11 and 0.76 ± 0.4 for SIMV and HFV, respectively. The arterial pressure variations observed in neonates on SIMV or HFV are related to cardiopulmonary interaction. Despite this relation, it is not likely that PPV will reliably predict fluid responsiveness in neonates due to physiological aliasing.
authors.affiliation: Department 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.
authors.forename: Linda
authors.initials: L
authors.lastname: Heskamp
authors.affiliation: MIRA-Institute for Biomedical Technology and of Technical Medicine, of the Faculty of Science and Technology, University of Twente, Enschede, The Netherlands Department of Intensive Care Medicine, Radboud university medical centre, Nijmegen, The Netherlands.
authors.forename: Benno
authors.initials: B
authors.lastname: Lansdorp
authors.affiliation: Department of Radiology, Radboud university medical centre, Nijmegen, The Netherlands.
authors.forename: Jeroen
authors.initials: J
authors.lastname: Hopman
authors.affiliation: Department of Intensive Care Medicine, Radboud university medical centre, Nijmegen, The Netherlands.
authors.forename: Joris
authors.initials: J
authors.lastname: Lemson
authors.affiliation: Department of Neonatology, Radboudum Amalia Children's Hospital, Nijmegen, The Netherlands willem.deboode@radboudumc.nl.
authors.forename: Willem-Pieter
authors.initials: WP
authors.lastname: de Boode
mesh_terms: D001794:Blood Pressure / Q000502:physiology*; D003430:Cross-Sectional Studies; D005260:Female; D006612:High-Frequency Ventilation; D006801:Humans; D007231:Infant, Newborn / Q000502:physiology*; D007234:Infant, Premature / Q000502:physiology*; D007385:Intermittent Positive-Pressure Ventilation; D008297:Male; D011446:Prospective Studies
keywords: Arterial blood pressure variability; fluid responsiveness; neonatal hemodynamics; neonates; pulse pressure variation