Mechanisms for episodes of hypoxemia in preterm infants undergoing mechanical ventilation☆,☆☆,★,★★
Section snippets
Study patients
Ten preterm infants with birth weights between 500 and 100 gm, who were undergoing ventilation and who had frequent unexplained episodes of pulse oximetry saturation (10 or more daily episodes of pulse oximetry saturation <85% lasting for 1 to 2 minutes) were the subjects of this study. These episodes were unexplained because they occurred without any obvious cause, such as a malfunction of the ventilator, a malposition of the endotracheal tube, an obstruction of the endotracheal tube with
Discussion
The results of this study indicate that most unexplained episodes of hypoxemia in preterm infants undergoing ventilation are triggered by a forced expiratory effort. This active exhalation produces a large decrease in lung volume, an increase in pulmonary resistance, and a drop in lung compliance. As a consequence of these changes, minute ventilation decreases. Evidence of an active expiration was provided by the increase in esophageal pressure that preceded every episode, indicating a rise in
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2021, Clinics in PerinatologyCitation Excerpt :The frequency of these episodes increases over the first weeks after birth, and they are influenced by the severity of their underlying lung disease.3–5 In mechanically ventilated infants episodes of IH are often associated with increased activity and forceful exhalations that lead to loss in lung volume and hypoventilation.6–9 In spontaneously breathing infants, IH is often associated with apneic events,10 but IH episodes triggered by forceful exhalations have also been observed.11
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From the Division of Neonatology, Department of Pediatrics, University of Miami School of Medicine, Miami, Florida
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Supported by the University of Miami Project: New Born.
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Reprint requests: Tilo Gerhardt, MD, Professor of Pediatrics, Department of Pediatrics (R-131), University of Miami School of Medicine, PO Box 016960, Miami, FL 33101.
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0022-3476/95/$5.00 + 0 9/23/67468