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1Fetal and Neonatal Research Group, Department of Physiology and 4Centre for Biomedical Engineering, Monash University; 2Department of Neonatal Services, Royal Women's Hospital; 3Department of Neonatology, Royal Children's Hospital; and 5Murdoch Children's Research Institute, Melbourne, Australia
Submitted 18 January 2005 ; accepted in final form 6 May 2005
In mature lungs, elevated positive end-expiratory pressure (PEEP) reduces pulmonary blood flow (PBF) and increases pulmonary vascular resistance (PVR). However, the effect of PEEP on PBF in preterm infants with immature lungs and a patent ductus arteriosus is unknown. Fetal sheep were catheterized at 124 days of gestation (term 
147 days), and a flow probe was placed around the left pulmonary artery to measure PBF. At 127 days, lambs were delivered and ventilated from birth with a tidal volume of 5 ml/kg and 4-cmH2O PEEP; PEEP was changed to 0, 8, and 12 cmH2O in random order, returning to 4 cmH2O between each change. Increasing PEEP from 4 to 8 cmH2O and from 4 to 12 cmH2O decreased PBF by 20.5 and 41.0%, respectively, and caused corresponding changes in PVR; reducing PEEP from 4 to 0 cmH2O did not affect PBF. Despite decreasing PBF, increasing PEEP from 4 to 8 cmH2O and 12 cmH2O improved oxygenation of lambs. Increasing and decreasing PEEP from 4 cmH2O significantly changed the contour of the PBF waveform; at a PEEP of 12 cmH2O, end-diastolic flow was reduced by 82.8% and retrograde flow was reestablished. Although increasing PEEP improves oxygenation, it adversely affects PBF and PVR shortly after birth, alters the PBF waveform, and reestablishes retrograde flow during diastole.
ventilation; pulmonary blood flow; fetus; preterm birth
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