Abstract
The effect of oxygen concentration on lowering pulmonary vascular resistance (PVR) during resuscitation in a model of persistent pulmonary hypertension of the newborn (PPHN) is not known. PPHN was induced in fetal lambs by ductal ligation 9 d before delivery. After delivery by cesarean section, resuscitation of PPHN lambs with 21%, 50%, or 100% O2 (n = 6 each) for 30 min produced similar decreases in PVR. Lambs were then ventilated with 50% O2 for 60 min and exposed to inhaled nitric oxide (iNO, 20 ppm). Initial resuscitation with 100% O2 significantly impaired the subsequent response to iNO compared with 21% O2 (42 ± 9% vs 22 ± 4% decrease from baseline PVR). Finally, each lamb was randomly and sequentially ventilated with 10%, 21%, 50%, or 100% O2. PVR decreased with increased concentrations of inhaled O2 up to 50%, there being no additional decrease in PVR with 100% O2. When PVR was correlated with Pao2, the maximal change in PVR was achieved at Pao2 values <60 mm Hg. We conclude that resuscitation with 100% O2 does not enhance pulmonary vasodilation compared with 21% and 50% O2, but impairs the subsequent response to iNO in PPHN lambs. Hypoxia increases PVR but hyperoxia does not confer significant additional pulmonary vasodilation in lambs with PPHN.
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Abbreviations
- ABG:
-
arterial blood gas
- BP:
-
blood pressure
- FiO2:
-
fraction of inspired oxygen
- PPHN:
-
persistent pulmonary hypertension of the newborn
- PA:
-
pulmonary artery
- Qp:
-
pulmonary blood flow
- PVR:
-
pulmonary vascular resistance
- ROS:
-
reactive oxygen species
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Acknowledgements
We thank Ikaria for providing iNO and Aeronox delivery systems.
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Supported by the American Academy of Pediatrics/Neonatal Resuscitation Program (S.L.) and Grant HL-54705 from the National Heart, Lung, and Blood Institute (R.H.S.).
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Lakshminrusimha, S., Swartz, D., Gugino, S. et al. Oxygen Concentration and Pulmonary Hemodynamics in Newborn Lambs With Pulmonary Hypertension. Pediatr Res 66, 539–544 (2009). https://doi.org/10.1203/PDR.0b013e3181bab0c7
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DOI: https://doi.org/10.1203/PDR.0b013e3181bab0c7
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