Abstract
The effects of a left to right shunt through a patent ductus arteriosus (PDA) on the mechanical properties of the lung were evaluated in 16 premature infants, mean BW 1130 g, GA 30 weeks. All infants required mechanical ventilation and pressure volume (P/V) curves were constructed using the difference between airway and esophageal pressure as transpulmonary pressure (PL) and the tidal volume measured simultaneously at different peak inspiratory pressures. Results of lung compliance (CL) (ml/cmH20×kg) were compared with those obtained in normal infants and prematures with hyaline membrane disease (HMD).Infants with PDA showed a low CL which only decreased slightly with increasing PL, reflecting an almost linear P/V curve. This is in contrast to the PV curve obtained in normal infants and in infants with HMD in whom after an initial linear portion there is a progressive flattening due to alveolar overdistension resulting in a decrease in CL. The decreased CL and the linear course of the P/V curve in infants with PDA may be due to increased interstitial fluid leading to a decrease in tissue elasticity that prevents alveolar overdistension. The characteristics of the P/V curve in infants with PDA can be used to differentiate between pulmonary failure secondary to PDA or HMD.
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