Changes in mean airway pressure during HFOV influences cardiac output in neonates and infants

Background: Changes in mean airway pressure affect cardiac output during conventional positive pressure ventilation. The effect of high-frequency oscillation ventilation (HFOV) on cardiac output is less studied. Methods: A prospective study in a university hospital pediatric intensive care unit. Fourteen patients aged <1 year and weighing <10 kg who were on HFOV were included. All patients had been on HFOV for >12 h and were considered to be in a stable condition. In the study group (n = 9) the mean proximal airway pressure (P-aw) was increased and decreased by +5 and -3 cmH(2)O, respectively, from baseline in each patient. Measurements were made at each level including baseline settings between each change. In a control group (n = 5) no changes in ventilatory parameters were made. Cardiac output was assessed with echocardiography and the Doppler technique at each level of P-aw and at similar intervals in the control group. Results: Cardiac output changed significantly when P-aw was changed in the study group (P = 0.02), with the greatest change at the highest P-aw at -11% (range: -19 to -9) compared with baseline. We found no significant changes over time in the control group. Conclusion: This study shows that CO is affected by changes in mean airway pressure during HFOV in concordance with the known effects of mean airway pressure during conventional positive pressure ventilation. The mean changes are smaller than expected compared with earlier studies of conventional mechanical ventilation. Further studies are needed to better understand these relationships.