scholarly journals Postnatal Systemic Blood Flow in Neonates with Abnormal Fetal Umbilical Artery Doppler

2014 ◽  
Vol 2014 ◽  
pp. 1-6
Author(s):  
Richelle N. Olsen ◽  
Jennifer Shepherd ◽  
Anup Katheria
Keyword(s):  
Blood Flow ◽  
Umbilical Artery ◽  
Superior Vena ◽  
Vena Cava ◽  
Adverse Outcomes ◽  
Systemic Blood ◽  
Systemic Blood Flow ◽  
Future Studies ◽  
Gestational Age At Delivery ◽  
Umbilical Artery Doppler

Objective. Abnormal umbilical artery Doppler (UAD) studies are associated with poor neonatal outcomes. We sought to determine if postnatal measures of systemic blood flow (SBF), as measured by functional echocardiography (fECHO), could identify which fetuses with abnormal UAD were at the highest risk of adverse outcomes. Study Design. This is a retrospective review of fetuses with abnormal UAD who received fECHO in the first 72 hours of life. Measures of SBF (right ventricular output (RVO) and superior vena cava (SVC) flow) were performed and compared with prenatal variables and postnatal outcomes. Result. 63 subjects had abnormal UAD, 20 of which also had fECHO. Six subjects had abnormal flow. Gestational age at delivery was similar between the two groups. Those with abnormal SBF had fewer days of abnormal UAD prior to delivery and developed RDS (P<0.001). Conclusion. Postnatal measures of SBF were associated with poor postnatal outcomes in fetuses with abnormal UAD. Future studies incorporating antenatal measures of SBF may help obstetricians determine which pregnancies complicated by UAD are likely to have postnatal morbidity.

Cord milking versus immediate clamping in preterm infants: a randomised controlled trial

2018 ◽  
Vol 104 (2) ◽  
pp. F145-F150 ◽  
Author(s):  
Walid El-Naggar ◽  
David Simpson ◽  
Arif Hussain ◽  
Anthony Armson ◽  
Linda Dodds ◽  
...  
Keyword(s):  
Blood Flow ◽  
Cardiac Output ◽  
Preterm Infants ◽  
Controlled Trial ◽  
Superior Vena ◽  
Tertiary Care ◽  
Vena Cava ◽  
Mean Difference ◽  
Systemic Blood ◽  
Systemic Blood Flow

ObjectiveTo investigate whether umbilical cord milking (UCM) at birth improves systemic blood flow and short-term outcomes, as compared with immediate cord clamping (ICC).DesignRandomised clinical trial.SettingSingle tertiary care centre.PatientsInfants born to eligible women presenting in preterm labour between 24 and 31 weeks’ gestation.InterventionsUCM three times at birth or ICC.Outcome measuresPrimary outcome included systemic blood flow as represented by echo-derived superior vena cava(SVC) flow at 4–6 hours after birth. The echocardiographer and interpreter were blinded to the randomisation. Secondary outcomes included cardiac output, neonatal morbidities and mortality. Analysis was by intention to treat.ResultsA total of 73 infants were randomised (37 to UCM and 36 to ICC). Mean (SD) gestational age was 27 (2) weeks and mean (SD) birth weight was 1040 (283) g. Haemoglobin on admission was higher in the UCM than in the ICC group (16.1 vs 15.0 g/L), p=0.049 (mean difference 1.1, 95% CI 0.003 to 2.2). No statistically significant differences were found between groups in SVC flow at 4–6 hours (88.9±37.8 and 107.3±60.1 mL/kg/min), p=0.13 (mean difference −18.4, 95% CI −41.7 to 5.0 mL/kg/min) or at 10–12 hours of age (102.5±41.8 and 90.6±28.4 mL/kg/min), p=0.17 (mean difference 12.0, 95% CI −4.7 to 28.7 mL/kg/min), cardiac output or neonatal morbidities.ConclusionsCord milking was not shown to improve functional cardiac outcomes, neonatal morbidity or mortality. More research is needed before routine cord milking can be recommended for very preterm infants.Trial registrationNCT01487187.

scholarly journals Evaluation of Optimization of Pulmonary and Systemic Blood Flow in Children after Bidirectional Cavapulmonary Anastomosis

2021 ◽  
pp. 57-62
Author(s):  
Ivan V. Dziuryi ◽  
Iaroslav P. Truba ◽  
Liliya M. Prokopovych ◽  
Vasyl V. Fylypchuk ◽  
Vasyl V. Lazoryshynets
Keyword(s):  
Blood Flow ◽  
Oxygen Saturation ◽  
Superior Vena Cava ◽  
Superior Vena ◽  
Vena Cava ◽  
Flow Ratio ◽  
Systemic Blood ◽  
Systemic Blood Flow ◽  
Blood Flow Ratio ◽  
Systemic Oxygen

In patients after bidirectional cavapulmonary anastomosis, blood flow through the superior vena cava (SVC), providing effective pulmonary blood flow, is the most important factor influencing blood oxygen saturation. Blood flow through the inferior vena cava recirculates into the systemic bloodstream. The study of the ratio of these flows will provide better understanding of the physiology of blood circulation after anastomosis and determine systemic oxygen saturation of blood and optimal time to perform surgery.   The aim. To determine volumetric blood flow in the SVC, calculate pulmonary to systemic blood flow ratio in children after bidirectional cavapulmonary anastomosis, and evaluate its contribution to cardiac output and oxygen saturation in systemic blood flow. Materials and methods. In the period from January 2010 to June 2021, 51 patients with congenital heart defects with depleted pulmonary blood flow underwent hemodynamic correction at the National Amosov Institute of Cardiovascular Surgery of the National Academy of Medical Sciences of Ukraine. There were 29 male patients (57%) and 22 female patients (43%). The mean age of the patients at the time of the surgery was 34 ± 18.2 months (2 to 120 months), the mean age of patients at the time of examination was 43.5 ± 28.4 months (12 to 134 months). The main method of diagnosis in determining the defect and assessing the immediate and long-term results was echocardiographic examination and probing of the heart cavities. To evaluate the optimization of pulmonary/systemic blood flow we used equations obtained using the Fick method. Pulmonary to systemic blood flow ratio was calculated separately for 35 patients. Among the examined 35 patients, 18 children were older than 2.5 years, so all the examined patients were conveniently divided into 2 age groups: I group (n = 17) up to 2.5 years, II group (n = 18) older than 2.5 years to assess the contribution of SVC to the systemic circulation depending on age. Results. Pulmonary to systemic blood flow ratio was calculated for 35 patients Qp/Qs = (82% – 66%) / (97% – 66%) = 0.52. The calculated cardiac index according to echocardiography was 4.0 ± 0.85 L/min/m2 which corresponds to the SVC saturation (r = 0.60, p = <0.001). The flow in the superior vena cava = 2.08 L/min/m2. There was a very interesting trend towards decrease in the average rate of systemic saturation in patients after bidirectional cavapulmonary anastomosis depending on age and duration of surgery. Thus, in 17 patients of group I, the calculated Qp/Qs was (84% – 67%) / (97% – 67%) = 0.57. In patients of group II, the average systemic oxygen saturation was 78 ± 2% (from 65% to 81%). Calculated Qp/Qs for 18 patients of group II = (78% – 66%) / (97% – 66%) = 0.39, which indicates a decrease in pulmonary to systemic ratio with the growth of the child. Decreased systemic saturation after bidirectional cavapulmonary anastomosis in patients with increasing age and body surface area is associated with a decrease in the proportional flow from the superior vena cava. Therefore, in our clinical material, we confirmed the phenomenon of change in pulmonary to systemic ratio depending on age, which was described by Salim et al. according to a study conducted on healthy babies. Conclusions. The contribution of SVC flow to total cardiac output after bidirectional cavapulmonary anastomosis is directly associated with the patient’s age and gradually decreases in older patients, as indicated by a decrease in systemic saturation, so the clinical effect of bidirectional cavapulmonary anastomosis may be significantly better when performing surgery in early childhood.

Distribution of pulmonary and bronchial blood supply to airways measured by fluorescent microspheres

1996 ◽  
Vol 80 (2) ◽  
pp. 430-436 ◽  
Author(s):  
S. L. Bernard ◽  
R. W. Glenny ◽  
N. L. Polissar ◽  
D. L. Luchtel ◽  
S. Lakshminarayan
Keyword(s):  
Blood Flow ◽  
Blood Supply ◽  
Pulmonary Blood Flow ◽  
Left Lung ◽  
Vena Cava ◽  
Fluorescent Microspheres ◽  
Systemic Blood ◽  
Systemic Blood Flow ◽  
Tissue Volume ◽  
Airway Walls

This study determined the relative contributions of systemic (bronchial) and pulmonary blood flow to the intraparenchymal airways =1 mm in diameter by using 15-mu m fluorescent microspheres and fluorescence microscopy in four dogs. Fluorescent microspheres of one color were injected into the inferior vena cava as a pulmonary blood flow marker, and fluorescent microspheres of another color were injected into the left ventricle as a systemic blood flow marker. After the second injection, the animals were killed and the lungs were excised and air dried at total lung capacity. The left lung was sliced into transverse planes and then sectioned into smaller blocks containing airways down to 1 mm in diameter. The blocks were then sectioned using a Vibratome and examined with a fluorescence microscope. Pulmonary and systemic blood flow markers were counted in airway walls, and the diameter of each airway was measured to determine the bronchial tissue volume. After a correction for the number of blood flow markers injected into each circulation, the average ratio of pulmonary to systemic blood flow markers seen in airway walls was 1:37, indicating that 97% of the blood supply to the intraparenchymal airways down to 1 mm in diameter was from the bronchial circulation. Furthermore, on the basis of a weighted least squares regression analysis, systemic (bronchial) blood flow per unit tissue volume increased as airway diameter decreased (P = 0.03).

Systemic blood flow to sheep lung: comparison of flow probes and microspheres

1992 ◽  
Vol 73 (5) ◽  
pp. 1996-2003 ◽  
Author(s):  
K. D. Ashley ◽  
D. N. Herndon ◽  
L. D. Traber ◽  
D. L. Traber ◽  
K. Deubel-Ashley ◽  
...  
Keyword(s):  
Blood Flow ◽  
Cardiac Output ◽  
Bronchial Artery ◽  
Left Lung ◽  
Vena Cava ◽  
Systemic Blood ◽  
Systemic Blood Flow ◽  
Flow Probe ◽  
Time Flow ◽  
Conscious Sheep

Discrepancies exist between experimental measurements of the systemic blood flow to sheep lung by use of microsphere techniques and flow probes on the bronchial artery. In these studies, we simultaneously measured the blood flow through the bronchial artery, using a transit time flow probe, and the systemic blood flow to left lung, using radioactive microspheres. All measurements were made on conscious sheep previously prepared with chronic catheterizations of the left atrium, aorta, and vena cava and a flow probe around the bronchial artery. Inflatable occluder cuffs were placed around the pulmonary and bronchoesophageal arteries. Bronchial artery blood flow in six sheep was 25.3 +/- 5.2 ml/min or 0.4% of the cardiac output. Systemic blood flow to left lung, measured with microspheres, was 54.1 +/- 14.2 ml/min. Calculated systemic blood flow to that portion of sheep lung perfused by the bronchial artery was 127.6 +/- 35.3 ml/min or 1.9% of cardiac output. Occlusion of the bronchoesophageal artery reduced bronchial artery flow to near zero, whereas total systemic blood to the lung was reduced by only 55%. Blood flow to the intraparenchymal cartilaginous airways was reduced 60–90% after occlusion of the bronchoesophageal artery. Sheep, like most mammals, have multiple and complex systemic arterial inputs to the lungs. We conclude that multiple branches of the bronchoesophageal artery provide most but not all of the systemic blood flow to the intraparenchymal cartilaginous airways but that over one-half of the total systemic blood flow to sheep lung comes from sources other than the common bronchial artery.

Regional pulmonary blood flow during 96 hours of hypoxia in conscious sheep

1986 ◽  
Vol 61 (6) ◽  
pp. 2136-2143 ◽  
Author(s):  
D. C. Curran-Everett ◽  
K. McAndrews ◽  
J. A. Krasney
Keyword(s):  
Blood Flow ◽  
Arterial Pressure ◽  
Pulmonary Blood Flow ◽  
Pulmonary Arterial Pressure ◽  
Pressor Response ◽  
Superior Vena ◽  
Acute Hypoxia ◽  
Vena Cava ◽  
Normobaric Hypoxia ◽  
Pulmonary Arterial

The effects of acute hypoxia on regional pulmonary perfusion have been studied previously in anesthetized, artificially ventilated sheep (J. Appl. Physiol. 56: 338–342, 1984). That study indicated that a rise in pulmonary arterial pressure was associated with a shift of pulmonary blood flow toward dorsal (nondependent) areas of the lung. This study examined the relationship between the pulmonary arterial pressor response and regional pulmonary blood flow in five conscious, standing ewes during 96 h of normobaric hypoxia. The sheep were made hypoxic by N2 dilution in an environmental chamber [arterial O2 tension (PaO2) = 37–42 Torr, arterial CO2 tension (PaCO2) = 25–30 Torr]. Regional pulmonary blood flow was calculated by injecting 15-micron radiolabeled microspheres into the superior vena cava during normoxia and at 24-h intervals of hypoxia. Pulmonary arterial pressure increased from 12 Torr during normoxia to 19–22 Torr throughout hypoxia (alpha less than 0.049). Pulmonary blood flow, expressed as %QCO or ml X min-1 X g-1, did not shift among dorsal and ventral regions during hypoxia (alpha greater than 0.25); nor were there interlobar shifts of blood flow (alpha greater than 0.10). These data suggest that conscious, standing sheep do not demonstrate a shift in pulmonary blood flow during 96 h of normobaric hypoxia even though pulmonary arterial pressure rises 7–10 Torr. We question whether global hypoxic pulmonary vasoconstriction is, by itself, beneficial to the sheep.

INTENSIVE CARE OF LIFE-THREATENING CONDITIONS IN PEDIATRIC ONCOHEMATOLOGY

2021 ◽  
Vol 100 (5) ◽  
pp. 138-144
Author(s):  
N.V. Matinyan ◽  
◽  
T.T. Valiev ◽  
K.I. Kirgizov ◽  
S.R. Varfolomeeva ◽  
...  
Keyword(s):  
Superior Vena ◽  
Tumor Lysis Syndrome ◽  
Vena Cava ◽  
Cord Compression ◽  
Adverse Outcomes ◽  
Malignant Neoplasms ◽  
Neutropenic Enterocolitis ◽  
Compression Syndrome ◽  
Life Threatening ◽  
Spinal Cord Compression Syndrome

Malignant neoplasms of the blood system in children are represented by highly aggressive variants, which at the stage of diagnosis and program chemotherapy can be complicated by the development of life-threatening conditions. Understanding the risk of possible complications allows you to effectively carry out preventive and therapeutic measures, to minimize adverse outcomes. This article presents modern approaches to the diagnosis and treatment of the most common life-threatening conditions in pediatric oncohematology: acute tumor lysis syndrome, typhlitis and neutropenic enterocolitis, superior vena cava syndrome, malignant airway compression syndrome, acute impairment of consciousness, spinal cord compression syndrome, thrombosis, methemoglobinemia.

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