Changes in pulmonary function during the diuretic phase of respiratory distress syndrome

• Published in: The Journal of pediatrics Vol. 101; no. 1; pp. 103 - 107
• Main Authors: Heaf, David P., Belik, Jaques, Spitzer, Alan R., Gewitz, Michael H., Fox, William W.
• Format: Journal Article
• Language: English
• Published: United States Mosby, Inc 01.07.1982
• Subjects: Diuresis; Female; Fluid Therapy; Humans; Infant, Newborn; Lung - physiopathology; Lung Volume Measurements; Male; Respiration, Artificial; Respiratory Distress Syndrome, Newborn - therapy; Respiratory Distress Syndrome, Newborn - urine; Respiratory Function Tests
• ISSN: 0022-3476; 1097-6833
• DOI: 10.1016/S0022-3476(82)80196-0

To evaluate the relationship between improvement in pulmonary function and spontaneous diuresis in respiratory distress syndrome, nine premature infants requiring mechanical ventilation for RDS were studied at a mean age of 11.9 hours prior to the onset of diuresis, at onset of diuresis, at maximum urine output (mean age 44.9 hours), and at 24 hours after maximum urine output. Prior to diuresis functional residual capacity decreased from mean±SEM of 16.2±2 to 13.3±1.2 ml/kg, and dynamic lung compliance decreased from 2.5±0.3 to 1.8±0.3 ml/cm H 2O ( P<0.05), indicating that the respiratory disease was worsening. There was no significant change in alveolar-arterial oxygen gradient, peak inflating pressure, or rate of intermittent mandatory ventilation over this period. At the time of maximum urine output, however, FRC had increased 36% ( P<0.05), C L had increased by 60% to 2.8±0.4 ml/cm H 2O ( P<0.025), aa DO 2 had decreased from 246±27 to 184±30 torr ( P<0.005), and PIP had decreased from 14.9±2.2 to 11.3±2.1 cm/H 2O ( P<0.05). On follow-up study 24 hours after maximum urine output, there was no further significant improvement in FRC, C L, or PIP, but IMV rate and aa DO 2 continued to decrease. These data show that the pulmonary function in RDS deteriorates until the onset of diuresis, after which it rapidly improves. This diuresis may represent the removal of excess lung liquid and seems necessary for improvement in RDS.