Pulmonary artery pressure: early predictor of chronic lung disease in preterm infants

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.

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Effect of repeated exercise on the lesser circulation

Journal of Applied Physiology ◽

10.1152/jappl.1963.18.5.983 ◽

1963 ◽

Vol 18 (5) ◽

pp. 983-986 ◽

Cited By ~ 35

Author(s):

Jiri Widimsky ◽

Erik Berglund ◽

Rolf Malmberg

Keyword(s):

Pulmonary Artery ◽

Lung Disease ◽

Pulmonary Artery Pressure ◽

Healthy Subjects ◽

Artery Pressure ◽

Repeated Exercise ◽

Exercise Period ◽

Pulmonary Arterial ◽

Lung Vessels ◽

Wedge Pressure

In four healthy subjects and four patients with lung disease, hemodynamic studies were done during two periods of identical exercise, 1 hr apart. Pulmonary artery pressure was lower in the second exercise period in all subjects studied. Pulmonary arterial wedge pressure was measured in four cases and was unchanged or even slightly increased. The “total pulmonary” and pulmonary vascular resistances were markedly lower in the second exercise period. The decrease in pulmonary artery pressure was found also in the second postexercise period when compared with the starting resting level. It is believed that this fall in pulmonary artery pressure and resistance was due to opening or widening of previously closed or constricted lung vessels. Repeated exercise must be used with caution when studying the effect of pharmacological or physiological agents on the lesser circulation. Submitted on November 30, 1962

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Correlation of grade of pulmonary artery pressure with six minutes walk distance and dyspnoea grading in group 3 pulmonary artery hypertension

International Journal of Advances in Medicine ◽

10.18203/2349-3933.ijam20180980 ◽

2018 ◽

Vol 5 (2) ◽

pp. 343 ◽

Cited By ~ 1

Author(s):

Aruna Shanmuganathan ◽

Advita G. ◽

Meenakshi N. ◽

Ragulan R. ◽

Nisha Ganga ◽

...

Keyword(s):

Pulmonary Hypertension ◽

Pulmonary Artery ◽

Lung Disease ◽

Pulmonary Artery Pressure ◽

Pulmonary Artery Hypertension ◽

Functional Profile ◽

Walk Distance ◽

Artery Pressure ◽

Group 3 ◽

Minute Walk

Background: Pulmonary Artery Hypertension (PAH) is defined as mean pulmonary artery pressure greater than 25 mmHg at rest as assessed by Right heart catheterization. 1 PAH secondary to lung disease is categorized under Group 3 PAH according to WHO classification, the major causes being COPD, ILD, OSA etc. Only few studies have analyzed the clinico-radiological profile, severity, morbidity and mortality associated with group 3 PAH. Hence this study was undertaken to study the clinic-radiological and functional profile of patients with group 3 pulmonary hypertension and to correlate grade of PAH with six-minute walk distance (6MWD) and Dyspnoea grading by modified Medical Research Council (mMRC). Primary objective was to correlate grade of PAH with 6MWD and dyspnoea grading (mMRC) in group 3 pulmonary artery hypertension. Secondary objective was to study the clinic- radiological and functional profile of patients with group 3 pulmonary hypertension in a tertiary care centre.Methods: Seventy two patients diagnosed to have PAH by 2D ECHO with underlying lung disease were retrospectively analyzed in Department of Respiratory Medicine, Chettinad Hospital and Research Institute, Chennai. Their demographic data, clinical history, examination, Dyspnoea according to MMRC grading, Chest X ray, CT chest, ECG, 2D ECHO (using VIVID 5), PFT (Easy on PC 2700-1-01. EOPC SN 219295, ATS guidelines), six minute walk test (ATS guidelines) and other Special investigations like CT Pulmonary Angiogram, Polysomnography were included wherever necessary.Results: Out of the 72 patients with group 3 PAH 44.4% belong to the age group of 46-65 years with a mean age of 57.59±13.6 years along with a slight male preponderance. The commonest cause being COPD (27.7%) followed by ILD (15.30%) and Bronchiectasis (5.50%) and the combined etiology contributing to 48.8%. There was a statistically significant positive correlation between grade of PAH and mMRC score (p< 0.05) and significant negative correlation between grade of PAH with 6MWD and FEV1 (p <0.05).Conclusions: This study shows that Simple bed side tools like 6MWD and mMRC score can be used for the evaluation of presence and severity of Group 3 PAH.

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