Aeration Strategy at Birth Does Not Impact Carotid Haemodynamics in Preterm Lambs

Abstract

ABSTRACTBackgroundThe impact of different respiratory strategies at birth on the preterm lung is well understood, however, concerns have been raised that lung recruitment may impede cerebral haemodynamics. This study aims to examine the effect of three different ventilation strategies on cerebral haemodynamics and oxygenation.Methods124-127 day gestation apnoeic intubated preterm lambs (n=68) being studied as part of a larger program primarily assessing lung injury were randomised to positive pressure ventilation with positive end-expiratory pressure (PEEP) 8 cmH2O (No-RM; n=12), sustained inflation (SI; n=15) or dynamic PEEP strategy (DynPEEP; maximum PEEP 14 or 20 cmH2O, n=41) at birth, followed by 90 minutes of standardised ventilation. Haemodynamic data was continuously recorded, with intermittent arterial blood gas analysis. Main outcome measures for this study included carotid blood flow, carotid artery oxygen content and carotid oxygen delivery.ResultsOverall carotid blood flow measures were comparable between strategies, with the exception of mean carotid blood flow which was significantly lower for the SI group compared to the No-RM and DynPEEP groups respectively over the first 3 minutes (p<0.0001, mixed-effects model). Carotid oxygen content and oxygen delivery were similar between strategies. Maximum PEEP did not alter cerebral haemodynamic measures.ConclusionAlthough there were some short-term variations in cerebral haemodynamics between different PEEP strategies and SI, these were not sustained.ImpactDifferent pressure strategies to facilitate lung aeration at birth in preterm infants have been proposed. There is minimal information on the effect of lung recruitment on cerebral haemodynamics.This is the first study that compares the effect of sustained lung inflation, and dynamic and static positive end-expiratory pressure on cerebral haemodynamics.We found that the different ventilation strategies did not alter carotid blood flow, carotid oxygen content or carotid oxygen delivery.This preclinical study provides some reassurance that respiratory strategies designed to focus on lung aeration at birth may not impact cerebral haemodynamics in preterm neonates.