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Regional distribution of blood volume within the preterm infant thorax during synchronised mechanical ventilation



Perfusion in healthy adults is gravity-dependent. Little is known about lung perfusion in the preterm infant. The aim of this study was to describe the regional distribution of blood volume within the thorax in preterm infants receiving synchronised volume-targeted mechanical ventilation (SIPPV + TTV) and to compare this to regional distribution of tidal ventilation using electrical impedance tomography (EIT).


Stable supine ventilated preterm infants (<32-week gestation) were studied. Three sets of artefact-free 30-s EIT recordings of the right hemithorax were filtered in the cardiac and respiratory frequency domains to differentiate impedance change due to blood (ΔZ c) and gas volume (ΔZ v). The distribution of ΔZ c and ΔZ v in the anterior-to-posterior regions of the right chest were compared. Infants were subdivided by age (≤7, >7 days) and oxygen requirement.


A total of 5,471 beats were analysed from 26 infants (78 recordings); mean (standard deviation (SD)) gestational age was 26 (2) weeks and mean (SD) postnatal age was 9 (10) days. The median (interquartile range) ΔZ c in the anterior half of the hemithorax was 1.41-fold (0.88–2.11) greater than that in the posterior half. The geometric centre of ΔZ c was located at 46.7% of the anterior-posterior thoracic distance, compared to a more centrally located ΔZ v (49.6%; p < 0.0001). The ΔZ vZ c ratio was 1.7 in the anterior third of the chest and 2.2 in the posterior (p < 0.0001). The area under the curve (AUC) analysis showed that ΔZ c was more evenly distributed in infants >7 days of age and not influenced by oxygen requirement.


There are gravity dependent differences in the distribution of blood volume and ventilation in the ventilated preterm chest.

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Fig. 1
Fig. 2
Fig. 3



Beats/breaths per minute


Countless impedance units


Electrical impedance tomography


Functional electrical impedance tomography

F IO2 :

Fraction of inspired oxygen concentration


Heart rate


Patent ductus arteriosus


Synchronised intermittent positive pressure ventilation


Synchronised volume-targeted intermittent positive pressure ventilation


Targeted tidal volume (volume guarantee)

ΔZ :

Change in thoracic impedance

ΔZ c :

Amplitude of impedance change in the cardiac frequency domain

ΔZ v :

Amplitude of impedance change in the respiratory frequency domain


  1. 1.

    van Kaam AH, Rimensberger PC (2007) Lung-protective ventilation strategies in neonatology: what do we know—what do we need to know? Crit Care Med 35:925–931

  2. 2.

    Dueck R (2006) Alveolar recruitment versus hyperinflation: a balancing act. Curr Opin Anaesthesiol 19:650–654

  3. 3.

    Gattinoni L, Carlesso E, Valenza F, Chiumello D, Caspani ML (2004) Acute respiratory distress syndrome, the critical care paradigm: what we learned and what we forgot. Curr Opin Crit Care 10:272–278

  4. 4.

    West JB (1978) Regional differences in the lung. Chest 74:426–437

  5. 5.

    Dries DJ (1998) Prone positioning in acute lung injury. J Trauma 45:849–852

  6. 6.

    Mure M, Lindahl SG (2001) Prone position improves gas exchange—but how? Acta Anaesthesiol Scand 45:150–159

  7. 7.

    Heaf DP, Helms P, Gordon I, Turner HM (1983) Postural effects on gas exchange in infants. N Engl J Med 308:1505–1508

  8. 8.

    Davies H, Kitchman R, Gordon I, Helms P (1985) Regional ventilation in infancy. Reversal of adult pattern. N Engl J Med 313:1626–1628

  9. 9.

    Davies H, Helms P, Gordon I (1992) Effect of posture on regional ventilation in children. Pediatr Pulmonol 12:227–232

  10. 10.

    Bhuyan U, Peters AM, Gordon I, Davies H, Helms P (1989) Effects of posture on the distribution of pulmonary ventilation and perfusion in children and adults. Thorax 44:480–484

  11. 11.

    Wolf GK, Arnold JH (2005) Noninvasive assessment of lung volume: respiratory inductance plethysmography and electrical impedance tomography. Crit Care Med 33[Suppl]:S163–S169

  12. 12.

    Vonk-Noordegraaf A, van Wolferen SA, Marcus JT, Boonstra A, Postmus PE, Peeters JW, Peacock AJ (2005) Noninvasive assessment and monitoring of the pulmonary circulation. Eur Respir J 25:758–766

  13. 13.

    Frerichs I, Dargaville PA, van GH, Morel DR, Rimensberger PC (2006) Lung volume recruitment after surfactant administration modifies spatial distribution of ventilation. Am J Respir Crit Care Med 174:772–779

  14. 14.

    Dunlop S, Hough J, Riedel T, Fraser JF, Dunster K, Schibler A (2006) Electrical impedance tomography in extremely prematurely born infants and during high frequency oscillatory ventilation analyzed in the frequency domain. Physiol Meas 27:1151–1165

  15. 15.

    Pillow JJ, Frerichs I, Stocks J (2006) Lung function tests in neonates and infants with chronic lung disease: global and regional ventilation inhomogeneity. Pediatr Pulmonol 41:105–121

  16. 16.

    Bodenstein M, David M, Markstaller K (2009) Principles of electrical impedance tomography and its clinical application. Crit Care Med 37:713–724

  17. 17.

    Brown BH, Primhak RA, Smallwood RH, Milnes P, Narracott AJ, Jackson MJ (2002) Neonatal lungs—can absolute lung resistivity be determined non-invasively? Med Biol Eng Comput 40:388–394

  18. 18.

    Smallwood RH, Hampshire AR, Brown BH, Primhak RA, Marven S, Nopp P (1999) A comparison of neonatal and adult lung impedances derived from EIT images. Physiol Meas 20:401–413

  19. 19.

    Marven SS, Hampshire AR, Smallwood RH, Brown BH, Primhak RA (1996) Reproducibility of electrical impedance tomographic spectroscopy (EITS) parametric images of neonatal lungs. Physiol Meas 17[Suppl]:A205–A212

  20. 20.

    Hampshire AR, Smallwood RH, Brown BH, Primhak RA (1995) Multifrequency and parametric EIT images of neonatal lungs. Physiol Meas 16[Suppl]:A175–A189

  21. 21.

    Frerichs I, Schiffmann H, Hahn G, Hellige G (2001) Non-invasive radiation-free monitoring of regional lung ventilation in critically ill infants. Intensive Care Med 27:1385–1394

  22. 22.

    Heinrich S, Schiffmann H, Frerichs A, Klockgether-Radke A, Frerichs I (2006) Body and head position effects on regional lung ventilation in infants: an electrical impedance tomography study. Intensive Care Med 32:1392–1398

  23. 23.

    Riedel T, Kyburz M, Latzin P, Thamrin C, Frey U (2009) Regional and overall ventilation inhomogeneities in preterm and term-born infants. Intensive Care Med 35:144–151

  24. 24.

    Frerichs I, Schiffmann H, Oehler R, Dudykevych T, Hahn G, Hinz J, Hellige G (2003) Distribution of lung ventilation in spontaneously breathing neonates lying in different body positions. Intensive Care Med 29:787–794

  25. 25.

    Schibler A, Yuill M, Parsley C, Pham T, Gilshenan K, Dakin C (2009) Regional ventilation distribution in non-sedated spontaneously breathing newborns and adults is not different. Pediatr Pulmonol 44:851–858

  26. 26.

    Vonk Noordegraaf A, Kunst PW, Janse A, Marcus JT, Postmus PE, Faes TJ, de Vries PM (1998) Pulmonary perfusion measured by means of electrical impedance tomography. Physiol Meas 19:263–273

  27. 27.

    Zadehkoochak M, Blott BH, Hames TK, George RF (1992) Pulmonary perfusion and ventricular ejection imaging by frequency domain filtering of EIT (electrical impedance tomography) images. Clin Phys Physiol Meas 13[Suppl]:A191–A196

  28. 28.

    Smit HJ, Vonk-Noordegraaf A, Marcus JT, Boonstra A, de Vries PM, Postmus PE (2004) Determinants of pulmonary perfusion measured by electrical impedance tomography. Eur J Appl Physiol 92:45–49

  29. 29.

    Smit HJ, Handoko ML, Vonk-Noordegraaf A, Faes TJ, Postmus PE, de Vries PM, Boonstra A (2003) Electrical impedance tomography to measure pulmonary perfusion: is the reproducibility high enough for clinical practice? Physiol Meas 24:491–499

  30. 30.

    Smit HJ, Vonk-Noordegraaf A, Marcus JT, van der Weijden S, Postmus PE, de Vries PM, Boonstra A (2003) Pulmonary vascular responses to hypoxia and hyperoxia in healthy volunteers and COPD patients measured by electrical impedance tomography. Chest 123:1803–1809

  31. 31.

    Frerichs I, Pulletz S, Elke G, Reifferscheid F, Schadler D, Scholz J, Weiler N (2009) Assessment of changes in distribution of lung perfusion by electrical impedance tomography. Respiration 77:282–291

  32. 32.

    Barber DC (1989) A review of image reconstruction techniques for electrical impedance tomography. Med Phys 16:162–169

  33. 33.

    Barber DC (1989) A sensitivity method for electrical impedance tomography. Clin Phys Physiol Meas 10:368–371

  34. 34.

    Nyren S, Mure M, Jacobsson H, Larsson SA, Lindahl SG (1999) Pulmonary perfusion is more uniform in the prone than in the supine position: scintigraphy in healthy humans. J Appl Physiol 86:1135–1141

  35. 35.

    Polglase GR, Morley CJ, Crossley KJ, Dargaville P, Harding R, Morgan DL, Hooper SB (2005) Positive end-expiratory pressure differentially alters pulmonary hemodynamics and oxygenation in ventilated, very premature lambs. J Appl Physiol 99:1453–1461

  36. 36.

    Tingay DG, Mills JF, Morley CJ, Pellicano A, Dargaville PA (2006) The deflation limb of the pressure–volume relationship in infants during high-frequency ventilation. Am J Respir Crit Care Med 173:414–420

  37. 37.

    Frerichs I, Hinz J, Herrmann P, Weisser G, Hahn G, Quintel M, Hellige G (2002) Regional lung perfusion as determined by electrical impedance tomography in comparison with electron beam CT imaging. IEEE Trans Med Imaging 21:646–652

  38. 38.

    Kunst PW, Vonk NA, Hoekstra OS, Postmus PE, de Vries PM (1998) Ventilation and perfusion imaging by electrical impedance tomography: a comparison with radionuclide scanning. Physiol Meas 19:481–490

  39. 39.

    Glenny RW, Bernard SL, Luchtel DL, Neradilek B, Polissar NL (2007) The spatial–temporal redistribution of pulmonary blood flow with postnatal growth. J Appl Physiol 102:1281–1288

  40. 40.

    Galvin I, Drummond GB, Nirmalan M (2007) Distribution of blood flow and ventilation in the lung: gravity is not the only factor. Br J Anaesth 98:420–428

  41. 41.

    Pulletz S, Elke G, Zick G, Schädler D, Scholz J, Weiler N, Frerichs I (2008) Performance of electrical impedance tomography in detecting regional tidal volumes during one-lung ventilation. Acta Anaesthesiol Scand 52:1131–1139

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The authors wish to thank Brenda Argus and Stephanie Tan-Kristanto for their assistance with this study. D.G.T. is supported by a National Health and Medical Research Council Clinical Research Fellowship (Grant ID 491286), P.G.D. is supported by a NHMRC Practitioner Fellowship.

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The authors declare that there are no competing interests.

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Correspondence to Hazel R. Carlisle.

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Carlisle, H.R., Armstrong, R.K., Davis, P.G. et al. Regional distribution of blood volume within the preterm infant thorax during synchronised mechanical ventilation. Intensive Care Med 36, 2101–2108 (2010). https://doi.org/10.1007/s00134-010-2049-4

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  • Infant
  • Preterm
  • Perfusion
  • Ventilation
  • Lung mechanics
  • Electrical impedance tomography