title: Relationship between Mean Airways Pressure, Lung Mechanics, and Right Ventricular Output during High-Frequency Oscillatory Ventilation in Infants.
abstract: To characterize changes in lung mechanics and right ventricular output (RVO) during incremental/decremental continuous distending pressure (CDP) maneuvers in newborn infants receiving high-frequency oscillatory ventilation, with the aim of evaluating when open lung maneuvers are needed and whether they are beneficial.
  
  
  
  Thirteen infants on high-frequency oscillatory ventilation were studied with a median (IQR) gestational age of 261(253-291) weeks and median (IQR) body weight of 810 (600-1020) g. CDP was increased stepwise from 8 cmH2O to a maximum pressure and subsequently decreased until oxygenation deteriorated or a CDP of 8 cmH2O was reached. The lowest CDP that maintained good oxygenation was considered the clinically optimal CDP. At each CDP, the following variables were evaluated: oxygenation, respiratory system reactance (Xrs), and RVO by Doppler echocardiography.
  
  
  
  At maximal CDP reached during the trial, 19 [1] cmH2O (mean [SEM]), oxygenation markedly improved, and Xrs and RVO decreased. During deflation, oxygenation remained stable over a wide range of CDP settings, Xrs returned to the baseline values, and RVO increased but the baseline values were not readily restored in all patients.
  
  
  
  These results suggest that Xrs and RVO are more sensitive than oxygenation to overdistension and they may be useful in clinical practice to guide open lung maneuvers.
authors.affiliation: Department of Electronics, Informatics and Bioengineering, Politecnico di Milano University, Milan, Italy.
authors.forename: Emanuela
authors.initials: E
authors.lastname: Zannin
authors.affiliation: Neonatal Intensive Care Unit, Fondazione MBBM, Monza, Italy.
authors.forename: Daniela
authors.initials: D
authors.lastname: Doni
authors.affiliation: Neonatal Intensive Care Unit, Fondazione MBBM, Monza, Italy.
authors.forename: Maria Luisa
authors.initials: ML
authors.lastname: Ventura
authors.affiliation: Neonatal Intensive Care Unit, Fondazione MBBM, Monza, Italy.
authors.forename: Tiziana
authors.initials: T
authors.lastname: Fedeli
authors.affiliation: Neonatal Intensive Care Unit, Fondazione MBBM, Monza, Italy.
authors.forename: Camilla
authors.initials: C
authors.lastname: Rigotti
authors.affiliation: Department of Electronics, Informatics and Bioengineering, Politecnico di Milano University, Milan, Italy.
authors.forename: Raffaele L
authors.initials: RL
authors.lastname: Dellacá
authors.affiliation: Neonatal Intensive Care Unit, Fondazione MBBM, Monza, Italy.
authors.forename: Paolo E
authors.initials: PE
authors.lastname: Tagliabue
mesh_terms: D002302:Cardiac Output; D005260:Female; D006612:High-Frequency Ventilation / Q000379:methods*; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D011312:Pressure; D015656:Respiratory Mechanics; D016278:Ventricular Function, Right
keywords: Doppler echocardiography; forced oscillation technique; infant, newborn; mechanical ventilation; pulmonary hemodynamics