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J Appl Physiol (May 12, 2005). doi:10.1152/japplphysiol.00055.2005
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Submitted on January 18, 2005
Accepted on May 6, 2005

Positive End-Expiratory Pressure Differentially Alters Pulmonary Hemodynamics and Oxygenation in Ventilated, Very Premature Lambs

Graeme R. Polglase1*, Colin J. Morley2, Kelly J. Crossley3, Peter Dargaville4, Richard Harding1, David L. Morgan5, and Stuart B. Hooper1

1 Department of Physiology, Monash University, Melbourne, Victoria, Australia
2 Department of Neonatal Services, Royal Women's Hospital, Melbourne, Victoria, Australia; Murdoch Children's Research Institute, Melbourne, Victoria, Australia
3 Department of Physiology, Monash University, Melbourne, Victoria, Australia; Murdoch Children's Research Institute, Melbourne, Victoria, Australia
4 Department of Neonatology, Royal Children's Hospital, Melbourne, Victoria, Australia; Murdoch Children's Research Institute, Melbourne, Victoria, Australia
5 Department of Neonatology, Royal Children's Hospital, Melbourne, Victoria, Australia

* To whom correspondence should be addressed. E-mail: gpolglase{at}obsgyn.uwa.edu.au.

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 are unknown. Fetal sheep were catheterised at 124 days gestation (term ~147 days) and a flow probe 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 re-established. Although increasing PEEP improves oxygenation, it adversely affects PBF and PVR shortly after birth, alters the PBF waveform and re-establishes retrograde flow during diastole.




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