scholarly journals Prediction of Extubation Readiness Using Transthoracic Ultrasound in Preterm Infants

2020 ◽  
Author(s):  
Reem M. Soliman ◽  
Yasser Elsayed ◽  
Reem N. Said ◽  
Abdulaziz M. Abdulbaqi ◽  
Rania H. Hashem ◽  
...  
Keyword(s):  
Pulmonary Artery ◽  
Preterm Infants ◽  
Pulmonary Artery Pressure ◽  
Neonatal Intensive Care ◽  
Ductus Arteriosus ◽  
Interventricular Septum ◽  
Area Under The Curve ◽  
Left Ventricular ◽  
Predictive Values ◽  
Artery Pressure

ABSTRACTObjectiveTo test the hypothesis that a lung ultrasound severity score (LUSsc) and assessment of left ventricular eccentricity index of the interventricular septum (LVEI) by focused heart ultrasound can predict extubation success in mechanically ventilated preterm infants with respiratory distress syndrome (RDS).DesignProspective observational study of premature infants <34 weeks’ of gestation age supported with mechanical ventilation due to RDS. LUSsc and LVEI were performed on postnatal days 3 and 7 by an investigator who was masked to infants’ ventilator parameters and clinical conditions. RDS was classified based on LUSsc into mild (score 0–9) and moderate-severe (score 10–18). A receiver operator curve was constructed to assess the ability to predict extubation success. Pearson’s correlation was performed between LVEI and pulmonary artery pressure (PAP).SettingLevel III neonatal intensive care unit, Cairo, Egypt.ResultsA total of 104 studies were performed to 66 infants; of them 39 had mild RDS (LUSsc 0–9) and 65 had moderate-severe RDS (score ≥10). LUSsc predicted extubation success with a sensitivity and a specificity of 91% and 69%; the positive and negative predictive values were 61% and 94%, respectively. Area under the curve (AUC) was 0.83 (CI: 0.75-0.91). LVEI did not differ between infants that succeeded and failed extubation. However, it correlated with pulmonary artery pressure during both systole (r=0.62) and diastole (r=0.53) and with hemodynamically significant patent ductus arteriosus (r=0.27 and r=0.46, respectively).ConclusionLUSsc predicts extubation success in preterm infants with RDS whereas LVEI correlates with high PAP.

Dopamine effects on pulmonary artery pressure in hypotensive preterm infants with patent ductus arteriosus

2002 ◽  
Vol 140 (3) ◽  
pp. 373-375 ◽  
Author(s):  
Jean-Michel Liet ◽  
Cécile Boscher ◽  
Christèle Gras-Leguen ◽  
Véronique Gournay ◽  
Thierry Debillon ◽  
...  
Keyword(s):  
Pulmonary Artery ◽  
Patent Ductus Arteriosus ◽  
Preterm Infants ◽  
Pulmonary Artery Pressure ◽  
Ductus Arteriosus ◽  
Artery Pressure ◽  
Patent Ductus

Inhibition of 20-HETE abolishes the myogenic response during NOS antagonism in the ovine fetal pulmonary circulation

2005 ◽  
Vol 289 (2) ◽  
pp. L261-L267 ◽  
Author(s):  
Thomas A. Parker ◽  
Theresa R. Grover ◽  
John P. Kinsella ◽  
John R. Falck ◽  
Steven H. Abman
Keyword(s):  
Pulmonary Artery ◽  
Pulmonary Artery Pressure ◽  
Pulmonary Circulation ◽  
Ductus Arteriosus ◽  
Combined Treatment ◽  
Specific Inhibitor ◽  
Fetal Lung ◽  
Myogenic Response ◽  
Fetal Sheep ◽  
Artery Pressure

Mechanisms that maintain high pulmonary vascular resistance (PVR) and oppose vasodilation in the fetal lung are poorly understood. In fetal lambs, increased pulmonary artery pressure evokes a potent vasoconstriction, suggesting that a myogenic response contributes to high PVR in the fetus. In adult systemic circulations, the arachidonic acid metabolite 20-hydroxyeicosatetraenoic acid (20-HETE) has been shown to modulate the myogenic response, but its role in the fetal lung is unknown. We hypothesized that acute increases in pulmonary artery pressure release 20-HETE, which causes vasoconstriction, or a myogenic response, in the fetal lung. To address this hypothesis, we studied the hemodynamic effects of N-methylsufonyl-12,12-dibromododec-11-enamide (DDMS), a specific inhibitor of 20-HETE production, on the pulmonary vasoconstriction caused by acute compression of the ductus arteriosus (DA) in chronically prepared fetal sheep. An inflatable vascular occluder around the DA was used to increase pulmonary artery pressure under three study conditions: control, after pretreatment with nitro-l-arginine (l-NA; to inhibit shear-stress vasodilation), and after combined treatment with both l-NA and a specific 20-HETE inhibitor, DDMS. We found that DA compression after l-NA treatment increased PVR by 44 ± 12%. Although intrapulmonary DDMS infusion did not affect basal PVR, DDMS completely abolished the vasoconstrictor response to DA compression in the presence of l-NA (44 ± 12% vs. 2 ± 4% change in PVR, l-NA vs. l-NA + DDMS, P < 0.05). We conclude that 20-HETE mediates the myogenic response in the fetal pulmonary circulation and speculate that pharmacological inhibition of 20-HETE might have a therapeutic role in neonatal conditions characterized by pulmonary hypertension.

scholarly journals A Simplified Ultrasound Comet Tail Grading Scoring to Assess Pulmonary Congestion in Patients with Heart Failure

2018 ◽  
Vol 2018 ◽  
pp. 1-10 ◽  
Author(s):  
Hong Li ◽  
Yi-Dan Li ◽  
Wei-Wei Zhu ◽  
Ling-Yun Kong ◽  
Xiao-Guang Ye ◽  
...  
Keyword(s):  
Heart Failure ◽  
Pulmonary Artery ◽  
Pulmonary Artery Pressure ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Systolic Pulmonary Artery Pressure ◽  
Pulmonary Congestion ◽  
Functional Classification ◽  
Artery Pressure ◽  
Patients With Heart Failure

Ultrasound lung comets (ULCs) are a nonionizing bedside approach to assess extravascular lung water. We evaluated a protocol for grading ULC score to estimate pulmonary congestion in heart failure patients and investigated clinical and echocardiographic correlates of the ULC score. Ninety-three patients with congestive heart failure, admitted to the emergency department, underwent pulmonary ultrasound and echocardiography. A ULC score was obtained by summing the ULC scores of 7 zones of anterolateral chest scans. The results of ULC score were compared with echocardiographic results, the New York Heart Association (NYHA) functional classification, radiologic score, and N-terminal pro-b-type natriuretic peptide (NT-proBNP). Positive linear correlations were found between the 7-zone ULC score and the following: E/e′, systolic pulmonary artery pressure, severity of mitral regurgitation, left ventricular global longitudinal strain, NYHA functional classification, radiologic score, and NT-proBNP. However, there was no significant correlation between ULC score and left ventricular ejection fraction, left ventricle diameter, left ventricular volume, or left atrial volume. A multivariate analysis identified the E/e′, systolic pulmonary artery pressure, and radiologic score as the only independent variables associated with ULC score increase. The simplified 7-zone ULC score is a rapid and noninvasive method to assess lung congestion. Diastolic rather than systolic performance may be the most important determinant of the degree of lung congestion in patients with heart failure.

scholarly journals Endothelin A Receptor Blockade Causes Adverse Left Ventricular Remodeling but Improves Pulmonary Artery Pressure After Infarction in the Rat

Circulation ◽  
1998 ◽  
Vol 98 (21) ◽  
pp. 2323-2330 ◽  
Author(s):  
Quang Trinh Nguyen ◽  
Peter Cernacek ◽  
Angelino Calderoni ◽  
Duncan J. Stewart ◽  
Pierre Picard ◽  
...  
Keyword(s):  
Pulmonary Artery ◽  
Pulmonary Artery Pressure ◽  
Ventricular Remodeling ◽  
Left Ventricular Remodeling ◽  
Left Ventricular ◽  
Receptor Blockade ◽  
Artery Pressure ◽  
Endothelin A Receptor ◽  
Endothelin A

scholarly journals Validity of Estimation of Pulmonary artery Pressure Using Continuous wave Doppler Echocardiography in Patient with Patent Ductus Arteriosus (PDA)

2012 ◽  
Vol 7 (1) ◽  
pp. 10-12 ◽  
Author(s):  
Chaudhury Meshkat Ahmed ◽  
Sohel Mahmud Arafat ◽  
Muhammad Khaled Hasan ◽  
Abed Hussain Khan ◽  
Lima Asrin Sayami ◽  
...  
Keyword(s):  
Pulmonary Artery ◽  
Patent Ductus Arteriosus ◽  
Pulmonary Artery Pressure ◽  
Doppler Echocardiography ◽  
Continuous Wave ◽  
Heart Diseases ◽  
Ductus Arteriosus ◽  
Artery Pressure ◽  
Bedside Test ◽  
Patent Ductus

Pulmonary artery pressure is one of the most important parameter for evaluating the status of pulmonary vascular bed for patients of PDA, which helps in formulating treatment strategy. This study was carried out in National Institute of Cardiovascular Diseases and Hospital (NICVD) and National Centre for Control of Rheumatic Fever and Heart Diseases, Dhaka, Bangladesh. Pulmonary artery pressure was recorded noninvasively using Doppler echocardiography and the it was correlated with those obtained from haemodynamic studies done at cardiac catheterization. Estimation of pulmonary artery pressure using Doppler derived measurement of pressure gradient across patent ductus arteriosus correlated well with that of simultaneous catheterization measured values. Doppler echocardiography is a cheap, simple, noninvasive bedside test for measuring pulmonary artery systolic and diastolic pressure in patient with PDA. DOI: http://dx.doi.org/10.3329/uhj.v7i1.10202 UHJ 2011; 7(1): 10-12

Acute effects of partial compression of ductus arteriosus on fetal pulmonary circulation

1989 ◽  
Vol 257 (2) ◽  
pp. H626-H634 ◽  
Author(s):  
S. H. Abman ◽  
F. J. Accurso
Keyword(s):  
Blood Flow ◽  
Pulmonary Artery ◽  
Pulmonary Vascular Resistance ◽  
Pulmonary Artery Pressure ◽  
Pulmonary Circulation ◽  
Pulmonary Blood Flow ◽  
Ductus Arteriosus ◽  
Base Line ◽  
Acute Effects ◽  
Artery Pressure

To determine the acute effects of increased pulmonary artery pressure and flow on the fetal pulmonary circulation, we studied the response of pulmonary blood flow and vascular reactivity to partial compression of the ductus arteriosus in 22 chronically prepared late-gestation fetal lambs. An inflatable occluder was placed loosely around the ductus arteriosus for compression. Partial compression of the ductus rapidly increased mean pulmonary artery pressure from 45 +/- 1 to 60 +/- 1 mmHg (mean +/- SE) and left pulmonary artery blood flow from 65 +/- 6 to 151 +/- 11 ml/min at 30 min (P less than 0.001; 12 animals). Despite keeping pulmonary artery pressure constant, pulmonary blood flow steadily declined and by 2 h was not different from base-line values. Pulmonary vascular resistance initially fell during the first 30 min of partial compression but then steadily increased and remained elevated above base-line values for at least 30 min after the release of the occluder (P less than 0.001). The decline of pulmonary vascular resistance during the first 30 min of compression was blunted after treatment with the cyclooxygenase inhibitor, meclofenamate (P less than 0.001; 6 animals). Rapid incremental ductus compressions demonstrated a decrease in the slope of the pressure-flow relationship from 3.30 +/- 0.27 (control) to 1.59 +/- 0.21 ml.min-1.mmHg-1 during the postcompression period (P less than 0.001; 12 animals). The vasodilation response to small increases of fetal PO2 was markedly blunted during the postcompression period (P less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

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