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Review

How Do We Monitor Oxygenation during the Management of PPHN? Alveolar, Arterial, Mixed Venous Oxygen Tension or Peripheral Saturation?

1
Division of Neonatology, Department of Pediatrics, University at Buffalo, Buffalo, NY 14260, USA
2
Division of Neonatology, Department of Pediatrics, University of California Davis, Davis, CA 95616, USA
*
Author to whom correspondence should be addressed.
Received: 18 August 2020 / Revised: 21 September 2020 / Accepted: 11 October 2020 / Published: 13 October 2020
(This article belongs to the Special Issue Pulmonary Hypertension in Neonates and Infants)
Oxygen is a pulmonary vasodilator and plays an important role in mediating circulatory transition from fetal to postnatal period. Oxygen tension (PO2) in the alveolus (PAO2) and pulmonary artery (PaO2) are the main factors that influence hypoxic pulmonary vasoconstriction (HPV). Inability to achieve adequate pulmonary vasodilation at birth leads to persistent pulmonary hypertension of the newborn (PPHN). Supplemental oxygen therapy is the mainstay of PPHN management. However, optimal monitoring and targeting of oxygenation to achieve low pulmonary vascular resistance (PVR) and optimizing oxygen delivery to vital organs remains unknown. Noninvasive pulse oximetry measures peripheral saturations (SpO2) and a target range of 91–95% are recommended during acute PPHN management. However, for a given SpO2, there is wide variability in arterial PaO2, especially with variations in hemoglobin type (HbF or HbA due to transfusions), pH and body temperature. This review evaluates the role of alveolar, preductal, postductal, mixed venous PO2, and SpO2 in the management of PPHN. Translational and clinical studies suggest maintaining a PaO2 of 50–80 mmHg decreases PVR and augments pulmonary vasodilator management. Nevertheless, there are no randomized clinical trials evaluating outcomes in PPHN targeting SpO2 or PO2. Also, most critically ill patients have umbilical arterial catheters and postductal PaO2 may not be an accurate assessment of oxygen delivery to vital organs or factors influencing HPV. The mixed venous oxygen tension from umbilical venous catheter blood gas may assess pulmonary arterial PO2 and potentially predict HPV. It is crucial to conduct randomized controlled studies with different PO2/SpO2 target ranges for the management of PPHN and compare outcomes. View Full-Text
Keywords: oxygenation; PPHN; oxygen tension oxygenation; PPHN; oxygen tension
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MDPI and ACS Style

Chandrasekharan, P.; Rawat, M.; Lakshminrusimha, S. How Do We Monitor Oxygenation during the Management of PPHN? Alveolar, Arterial, Mixed Venous Oxygen Tension or Peripheral Saturation? Children 2020, 7, 180. https://0-doi-org.brum.beds.ac.uk/10.3390/children7100180

AMA Style

Chandrasekharan P, Rawat M, Lakshminrusimha S. How Do We Monitor Oxygenation during the Management of PPHN? Alveolar, Arterial, Mixed Venous Oxygen Tension or Peripheral Saturation? Children. 2020; 7(10):180. https://0-doi-org.brum.beds.ac.uk/10.3390/children7100180

Chicago/Turabian Style

Chandrasekharan, Praveen, Munmun Rawat, and Satyan Lakshminrusimha. 2020. "How Do We Monitor Oxygenation during the Management of PPHN? Alveolar, Arterial, Mixed Venous Oxygen Tension or Peripheral Saturation?" Children 7, no. 10: 180. https://0-doi-org.brum.beds.ac.uk/10.3390/children7100180

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