Abstract
The different ventilatory pattern of HFOV and conventional ventilation (IPPV) may differently affect cerebral hemodynamics in neonates. Using color Doppler sonography we measured left ventricular output (LVO), the mean blood flow velocity (BFV,cm/s) in the median cerebral artery (MCA) and in the great cerebral vein (GCV) in 10 critically ill neonates [GA 27 (25-37) wks, weight 980 530-2500) g, age a (1-36) d] during IPPV and 3 (2-18) h after initiating HFOV (Infant Star). Indication for HFOV: Air leak (n = 8), failure of IPPV (n = 2).RESULTS: Data are medain and range. MAP = mean airway pressure (mmHg) OI = oxygenation index (OI = FiO2 × MAP × 100 / paO2). * = p < 0.05.During IPPV, LVO was low and MCA-BFV normal compared to data of 54 stable ventilated (IPPV) preterm neonates [GA 28(23-35)wks; LVO: 248(212-316), mean MCA-BFV: 10(5-28)]. During HFOV the blood flow in the MCA was oscillating synchroneously with the oscillations of the ventilator and arterial cerebral BFV was increased in all infants (increased pCO2) compared to IPPV. Venous cerebral BFV however was decreased (up to 45%), possibly due to the increased PEEP during HFOV. CONCLUSION: HFOV affects cerebral hemodynamics and may cause cerebral congestion in neonates at risk of intracranial hemorrhage.
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