Non-invasive measurement of reduced ventilation:perfusion ratio and shunt in infants with bronchopulmonary dysplasia: a physiological definition of the disease

Archives of Disease in Childhood. Fetal and Neonatal Edition
D QuineB J Stenson

Abstract

An objective definition of bronchopulmonary dysplasia (BPD) is required to interpret trial outcomes and provide a baseline for prognostic studies. Current definitions do not quantify disease severity. The cardinal measures of impaired gas exchange are a reduced ventilation:perfusion ratio (V(A):Q) and increased right to left shunt. These can be determined non-invasively by plotting arterial oxygen saturation (Spo(2)) against inspired oxygen pressure (PIo(2)). To describe the reduced V(A):Q and shunt in infants with BPD and evaluate these as graded measures of pulmonary dysfunction. 21 preterm infants with BPD were studied. PIo(2) was changed stepwise to vary Spo(2) between 86% and 94%. Pairs of PIo(2) and Spo(2) data points for each infant were plotted and analysed to derive reduced V(A):Q ratio and shunt. In every infant, the Spo(2) versus PIo(2) curve was shifted to the right of the normal because of a reduced V(A):Q. The mean (SD) shift was 16.5 (4.7) kPa (normal 6 kPa). Varying degrees of shunt were also present, but these were less important in determining Spo(2) within the studied range. The degree of shift was strongly predictive of the PIo(2) required to achieve any Spo(2) within the range 86-94% (R(2)>0.9), permitting ...Continue Reading

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Citations

Jun 5, 2010·American Journal of Respiratory and Critical Care Medicine·Scott A SandsPhilip J Berger
Jan 10, 2014·Journal of Clinical Monitoring and Computing·Geoffrey G LockwoodJ Gareth Jones
Apr 10, 2010·American Journal of Respiratory and Critical Care Medicine·Joseph FawkeJanet Stocks
Mar 7, 2009·Chest·Amit GuptaGareth Jones
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Feb 26, 2015·Annals of the American Thoracic Society·Nicolas BamatHaresh Kirpalani
Oct 29, 2013·The Journal of Pediatrics·Sotirios FouzasEdgar Delgado-Eckert
Sep 17, 2016·Archives of Disease in Childhood. Fetal and Neonatal Edition·Peter A DargavilleTimothy J Gale
Mar 16, 2018·European Respiratory Review : an Official Journal of the European Respiratory Society·Francesca CiuffiniDavid G Tingay
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Dec 25, 2016·Journal of Clinical Monitoring and Computing·Theodore DassiosAnne Greenough
May 9, 2021·Archives of Disease in Childhood. Fetal and Neonatal Edition·Peter A DargavilleTimothy J Gale
May 16, 2021·Archives of Disease in Childhood. Fetal and Neonatal Edition·Patricia Lee WoodsAndrew William Gill

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