Abstract
We have previously demonstrated that fluctuating cerebral blood flow velocity and arterial blood pressure (ABP) are associated with intraventricular hemorrhage (NEJM 309, 1983). The cause of these ABP fluctuations (ABP Flues) is unknown. In the present study we determined the relation of respiratory muscle activity to fluctuations in ABP. We studied four preterm infants on ventilators for RDS with ABP Flucs. We monitored esophageal (Pes), gastric (Pg), and ABP pressure. Consistent findings were: 1) ABP flucs have the same frequency and direction of change as Pes and Pg changes associated with spontaneous breathing; 2) spontaneous apneic pauses were accompanied by sudden and complete cessation of ABP Flucs; 3) large cough-like swings in Pes and Pg, seen in all infants were associated with the largest ABP Flucs; 4) cutaneous stimulation had no effect on ABP Flucs provided no change in Pes and Pg occurred; 5) respirator pressure swings had only small effects on ABP Flucs in one infant; 6) the effects of change in Pes and Pg on ABP were nearly simultaneous (0.05-.2 s.), thus respiratory pressure changes appeared to be superimposed on cardiac swings in ABP. These findings suggest that the fluctuations in ABP are caused by two mechanisms: 1) direct transmission of pleural and abdominal pressure to the cardiovascular system during spontaneous breathing and/or 2) fluctuations in venous return produced by breathing pressures. (Funding NIH HD 10993)
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Perlman, J., Thach, B. 1480 Respiratory Origin of the Fluctuations in Blood Pressure Associated with Intraventricular Hemorrhage in Preterm Infants. Pediatr Res 19, 357 (1985). https://doi.org/10.1203/00006450-198504000-01504
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DOI: https://doi.org/10.1203/00006450-198504000-01504