Pulmonary hemodynamics and vascular reactivity in asphyxiated term lambs resuscitated with 21 and 100 oxygen

摘要

An increase in oxygen tension is an important factor in decreasing pulmonary vascular resistance (PVR) at birth. Birth asphyxia results in acidosis and increased PVR. We determined the effect of resuscitation with 21 vs. 100% O2 on pulmonary hemodynamics, pulmonary arterial (PA) reactivity, and oxidant stress in a lamb model of in utero asphyxia. Term fetal lambs were acutely asphyxiated by intrauterine umbilical cord occlusion for 10 min resulting in acidosis (pH 6.96 ± 0.05 and Pco2 103 ± 5 Torr), bradycardia, systemic hypotension, and increased PVR. Lambs were treated with 30 min of resuscitation with 21% or 100% O2 (n = 6 each). PaO2 was significantly elevated with 100% O2 resuscitation compared with 21% O2 (430 ± 38 vs. 64 ± 8 Torr), but changes in pH and PaCO2 were similar. The 100% O2 induced greater increase in pulmonary blood flow and decrease in PVR at 1 min of life, but subsequent values were similar to 21% O2 group between 2 and 30 min of life. Oxygen uptake from the lung and systemic oxygen extraction was similar between the two groups. Pulmonary arteries showed increased staining for superoxide anions and increased contractility to norepinephrine following resuscitation with 100% O2. The increased PA contractility induced by 100% O2 was reversed by scavenging superoxide anions with superoxide dismutase and catalase. We conclude that resuscitation of asphyxiated lambs with 100% O2 increases PaO2 but does not improve lung oxygen uptake, decrease PVR at 30 min, or increase systemic oxygen extraction ratios. Furthermore, 100% O₂ also induces oxidative stress and increases PA contractility. These findings support the new neonatal resuscitation guidelines recommending 21% O₂ for initial resuscitation of asphyxiated neonates.