Effect of various inspired oxygen concentrations on pulmonary and systemic hemodynamics and oxygenation during resuscitation in a transitioning preterm model

Praveen Chandrasekharan, Munmun Rawat, Sylvia F. Gugino, Carmon Koenigsknecht, Justin Helman, Jayasree Nair, Payam Vali, Satyanarayana Lakshminrusimha

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Background: The Neonatal Resuscitation Program recommends initial resuscitation of preterm infants with low oxygen (O2) followed by titration to target preductal saturations (SpO2). We studied the effect of resuscitation with titrated O2 on gas exchange, pulmonary, and systemic hemodynamics. Methodology: Twenty-nine preterm lambs (127 d gestation) were randomized to resuscitation with 21% O2 (n = 7), 100% O2 (n = 6), or initiation at 21% and titrated to target SpO2 (n = 16). Seven healthy term control lambs were ventilated with 21% O2. Results: Preductal SpO2 achieved by titrating O2 was within the desired range similar to term lambs in 21% O2. Resuscitation of preterm lambs with 21% and 100% O2 resulted in SpO2 below and above the target, respectively. Ventilation of preterm lambs with 100% O2 and term lambs with 21% O2 effectively decreased pulmonary vascular resistance (PVR). In contrast, preterm lambs with 21% O2 and titrated O2 demonstrated significantly higher PVR than term lambs on 21% O2. Conclusion(s): Initial resuscitation with 21% O2 followed by titration of O2 led to suboptimal pulmonary vascular transition at birth in preterm lambs. Ventilation with 100% O2 in preterm lambs caused hyperoxia but reduced PVR similar to term lambs on 21% O2. Studies evaluating the initiation of resuscitation at a higher O2 concentration followed by titration based on SpO2 in preterm neonates are needed.

Original languageEnglish (US)
Pages (from-to)1-8
Number of pages8
JournalPediatric Research
DOIs
StateAccepted/In press - Jun 2 2018

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Resuscitation
Hemodynamics
Oxygen
Lung
Vascular Resistance
Ventilation
Pulmonary Gas Exchange
Hyperoxia
Premature Birth
Premature Infants
Blood Vessels
Newborn Infant
Pregnancy

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

Effect of various inspired oxygen concentrations on pulmonary and systemic hemodynamics and oxygenation during resuscitation in a transitioning preterm model. / Chandrasekharan, Praveen; Rawat, Munmun; Gugino, Sylvia F.; Koenigsknecht, Carmon; Helman, Justin; Nair, Jayasree; Vali, Payam; Lakshminrusimha, Satyanarayana.

In: Pediatric Research, 02.06.2018, p. 1-8.

Research output: Contribution to journalArticle

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abstract = "Background: The Neonatal Resuscitation Program recommends initial resuscitation of preterm infants with low oxygen (O2) followed by titration to target preductal saturations (SpO2). We studied the effect of resuscitation with titrated O2 on gas exchange, pulmonary, and systemic hemodynamics. Methodology: Twenty-nine preterm lambs (127 d gestation) were randomized to resuscitation with 21{\%} O2 (n = 7), 100{\%} O2 (n = 6), or initiation at 21{\%} and titrated to target SpO2 (n = 16). Seven healthy term control lambs were ventilated with 21{\%} O2. Results: Preductal SpO2 achieved by titrating O2 was within the desired range similar to term lambs in 21{\%} O2. Resuscitation of preterm lambs with 21{\%} and 100{\%} O2 resulted in SpO2 below and above the target, respectively. Ventilation of preterm lambs with 100{\%} O2 and term lambs with 21{\%} O2 effectively decreased pulmonary vascular resistance (PVR). In contrast, preterm lambs with 21{\%} O2 and titrated O2 demonstrated significantly higher PVR than term lambs on 21{\%} O2. Conclusion(s): Initial resuscitation with 21{\%} O2 followed by titration of O2 led to suboptimal pulmonary vascular transition at birth in preterm lambs. Ventilation with 100{\%} O2 in preterm lambs caused hyperoxia but reduced PVR similar to term lambs on 21{\%} O2. Studies evaluating the initiation of resuscitation at a higher O2 concentration followed by titration based on SpO2 in preterm neonates are needed.",
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AU - Rawat, Munmun

AU - Gugino, Sylvia F.

AU - Koenigsknecht, Carmon

AU - Helman, Justin

AU - Nair, Jayasree

AU - Vali, Payam

AU - Lakshminrusimha, Satyanarayana

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AB - Background: The Neonatal Resuscitation Program recommends initial resuscitation of preterm infants with low oxygen (O2) followed by titration to target preductal saturations (SpO2). We studied the effect of resuscitation with titrated O2 on gas exchange, pulmonary, and systemic hemodynamics. Methodology: Twenty-nine preterm lambs (127 d gestation) were randomized to resuscitation with 21% O2 (n = 7), 100% O2 (n = 6), or initiation at 21% and titrated to target SpO2 (n = 16). Seven healthy term control lambs were ventilated with 21% O2. Results: Preductal SpO2 achieved by titrating O2 was within the desired range similar to term lambs in 21% O2. Resuscitation of preterm lambs with 21% and 100% O2 resulted in SpO2 below and above the target, respectively. Ventilation of preterm lambs with 100% O2 and term lambs with 21% O2 effectively decreased pulmonary vascular resistance (PVR). In contrast, preterm lambs with 21% O2 and titrated O2 demonstrated significantly higher PVR than term lambs on 21% O2. Conclusion(s): Initial resuscitation with 21% O2 followed by titration of O2 led to suboptimal pulmonary vascular transition at birth in preterm lambs. Ventilation with 100% O2 in preterm lambs caused hyperoxia but reduced PVR similar to term lambs on 21% O2. Studies evaluating the initiation of resuscitation at a higher O2 concentration followed by titration based on SpO2 in preterm neonates are needed.

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