Beat-to-beat blood pressure variability and patent ductus arteriosus in ventilated, premature infants

The aim of the present study was to test the hypothesis that a relationship exists between respiratory-induced blood pressure variability (BPV) and transductal shunting in premature infants with respiratory distress. Ten premature infants (27–32 weeks gestation) with respiratory distress ventilated in the synchronised, positive-pressure mode were examined. The interrelations between blood pressure and transthoracic impedance were described using time and frequency domain analysis. Haemodynamic effects of left-to-right transductal shunting were assessed using Doppler echocardiography (ratio of diastolic flow to systolic flow in the subdiaphragmatic aorta). The dependence of blood pressure fluctuations on the respiratory cycle was seen consistently in both time-domain and cross-spectral analysis. The amplitude of these fluctuations varied between infants. In the time domain, the beat-to-beat pressure difference was 0.69–4.1 mmHg for diastolic and 0.99–5.24 mmHg for systolic blood pressure. There was a positive linear relationship between the respiratory-related BPV indicators and the extent of left-to-right transductal shunting (r=0.86 for diastolic and 0.80 for systolic pressure, P<0.01). Respiratory-related BPV was not correlated to the indicators of left ventricle preload. It is concluded that respiratory related BPV involves both diastolic and systolic blood pressure and is correlated to the magnitude of left-to-right transductal shunting in the population studied.