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Stoecklin B, Veneroni C, Choi YJ, Pillow JJ, Dellacà RL. Respiratory and chest wall mechanics in very preterm infants. J Appl Physiol (1985) 2024; 136:1499-1506. [PMID: 38634505 DOI: 10.1152/japplphysiol.00561.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 04/11/2024] [Accepted: 04/11/2024] [Indexed: 04/19/2024] Open
Abstract
Data on static compliance of the chest wall (Ccw) in preterm infants are scarce. We characterized the static compliance of the lung (CL) and Ccw to determine their relative contribution to static compliance of the respiratory system (Crs) in very preterm infants at 36 wk postmenstrual age (PMA). We also aimed to investigate how these compliances were influenced by the presence of bronchopulmonary dysplasia (BPD) and impacted breathing variables. Airway opening pressure, esophageal pressure, and tidal volume (VT) were measured simultaneously during a short apnea evoked by the Hering-Breuer reflex. We computed tidal breathing variables, airway resistance (R), and dynamic lung compliance (CL,dyn), inspiratory capacity (IC), and Crs, CL, and Ccw. Functional residual capacity was assessed by the multiple breath washout technique (FRCmbw). Breathing variables, compliances, and lung volumes were adjusted for body weight. Twenty-three preterm infants born at 27.2 ± 2.0 wk gestational age (GA) were studied at 36.6 ± 0.6 wk PMA. Median and interquartile range (IQR) Crs/kg is 0.69 (0.6), CL/kg 0.95 (1.0), and Ccw/kg 3.0 (2.4). Infants with BPD (n = 11) had lower Crs/kg (P = 0.013), CL/kg (P = 0.019), and Ccw/kg (P = 0.027) compared with infants without BPD. Ccw/CL ratio was equal between groups. FRCmbw/kg (P = 0.044) and IC/kg (P = 0.005) were decreased in infants with BPD. Infants with BPD have reduced static compliance of the respiratory system, the lungs, and chest wall. Decreased Crs, CL, and Ccw in infants with BPD explain the lower FRC and IC seen in these infants.NEW & NOTEWORTHY Data on chest wall compliance in very preterm infants in the postsurfactant era are scarce. To our knowledge, we are the first group to report data on static respiratory system compliance (Crs), lung compliance (CL), and chest wall compliance (Ccw) in preterm infants with and without bronchopulmonary dysplasia (BPD) in the postsurfactant era.
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Affiliation(s)
- Benjamin Stoecklin
- School of Human Sciences, University of Western Australia, Perth, Western Australia, Australia
- King Edward Memorial Hospital, Perth, Western Australia, Australia
- Department of Neonatology, University Children's Hospital Basel (UKBB), Basel, Switzerland
| | - Chiara Veneroni
- Dipartimento di Elettronica, Informazione e Bioingegneria-DEIB, Politecnico di Milano University, Milan, Italy
| | - Y Jane Choi
- School of Human Sciences, University of Western Australia, Perth, Western Australia, Australia
- Wal-yan Respiratory Research Centre, Telethon Kids Institute, Perth, Western Australia, Australia
| | - J Jane Pillow
- School of Human Sciences, University of Western Australia, Perth, Western Australia, Australia
- Wal-yan Respiratory Research Centre, Telethon Kids Institute, Perth, Western Australia, Australia
| | - Raffaele L Dellacà
- Dipartimento di Elettronica, Informazione e Bioingegneria-DEIB, Politecnico di Milano University, Milan, Italy
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2
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Scottoline B, Jordan BK, Parkhotyuk K, Schilling D, McEvoy CT. Perioperative Improvement in Pulmonary Function in Infants with Congenital Diaphragmatic Hernia. J Pediatr 2023; 253:173-180.e2. [PMID: 36181873 DOI: 10.1016/j.jpeds.2022.09.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Revised: 08/26/2022] [Accepted: 09/23/2022] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The objective of this study was to compare serial changes in pulmonary function in contemporary infants with congenital diaphragmatic hernia managed with a gentle ventilation approach. STUDY DESIGN Observational cohort, single-center study of infants ≥350/7 weeks gestation at delivery with congenital diaphragmatic hernia. Functional residual capacity (FRC), passive respiratory compliance, and passive respiratory resistance were measured presurgical and postsurgical repair and within 2 weeks of discharge. A 1-way analysis of variance for repeated measures was used to evaluate the change in FRC, passive respiratory compliance, and passive respiratory resistance over these repeated measures. RESULTS Twenty-eight infants were included in the analysis with a mean gestational age of 38.3 weeks and birth weight of 3139 g. We found a significant increase in FRC across the 3 time points (mean in mL/kg [SD]: 10.9 [3.6] to 18.5 [5.2] to 24.2 [4.4]; P < .0001). There was also a significant increase in passive respiratory compliance and decrease in passive respiratory resistance. In contrast to a previous report, there were survivors in the current cohort with a preoperative FRC of <9 mL/kg. The mean FRC measured at discharge was in the range considered within normal limits. Sixteen infants had prenatal measurements of the lung-to-head ratio, but there was no relationship between the lung-to-head ratio and preoperative or postoperative FRC measurements. CONCLUSIONS Infants with congenital diaphragmatic hernia demonstrate significant increases in FRC and improvements in respiratory mechanics measured preoperatively and postoperatively and at discharge. We speculate these improvements are due to the surgical resolution of the mechanical obstruction to lung recruitment and that after achieving preoperative stability, repair should not be delayed given these demonstrable postoperative improvements.
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Affiliation(s)
- Brian Scottoline
- Division of Neonatology, Department of Pediatrics, Oregon Health & Science University, Portland, OR.
| | - Brian K Jordan
- Division of Neonatology, Department of Pediatrics, Oregon Health & Science University, Portland, OR
| | - Kseniya Parkhotyuk
- Division of Neonatology, Department of Pediatrics, Oregon Health & Science University, Portland, OR
| | - Diane Schilling
- Division of Neonatology, Department of Pediatrics, Oregon Health & Science University, Portland, OR
| | - Cindy T McEvoy
- Division of Neonatology, Department of Pediatrics, Oregon Health & Science University, Portland, OR
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3
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Muttoo S, Jeena PM, Röösli M, de Hoogh K, Meliefste K, Tularam H, Olin AC, Carlsen HK, Mentz G, Asharam K, Naidoo RN. Effect of short-term exposure to ambient nitrogen dioxide and particulate matter on repeated lung function measures in infancy: A South African birth cohort. ENVIRONMENTAL RESEARCH 2022; 213:113645. [PMID: 35700764 DOI: 10.1016/j.envres.2022.113645] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 06/02/2022] [Accepted: 06/06/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND The developing lung is highly susceptible to environmental toxicants, with both short- and long-term exposure to ambient air pollutants linked to early childhood effects. This study assessed the short-term exposure effects of nitrogen dioxide (NO2) and particulate matter (PM10) on lung function in infants aged 6 weeks, 6, 12 and 24 months, the early developmental phase of child growth. METHODS Lung function was determined by multiple breath washout and tidal breathing measurement in non-sedated infants. Individual exposure to NO2 and PM10 was determined by hybrid land use regression and dispersion modelling, with two-week average estimates (preceding the test date). Linear mixed models were used to adjust for the repeated measures design and an age*exposure interaction was introduced to obtain effect estimates for each age group. RESULTS There were 165 infants that had lung function testing, with 82 of them having more than one test occasion. Exposure to PM10 (μg/m3) resulted in a decline in tidal volume at 6 weeks [-0.4 ml (-0.9; 0.0), p = 0.065], 6 months [-0.5 ml (-1.0; 0.0), p = 0.046] and 12 months [-0.3 ml (-0.7; 0.0), p = 0.045]. PM10 was related to an increase in respiratory rate and minute ventilation, while a decline was observed for functional residual capacity for the same age groups, though not statistically significant for these outcomes. Such associations were however less evident for exposure to NO2, with inconsistent changes observed across measurement parameters and age groups. CONCLUSION Our study suggests that PM10 results in acute lung function impairments among infants from a low-socioeconomic setting, while the association with NO2 is less convincing.
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Affiliation(s)
- S Muttoo
- Discipline of Occupational and Environmental Health, University of KwaZulu-Natal, Durban, South Africa.
| | - P M Jeena
- Discipline of Paediatrics and Child Health, University of KwaZulu-Natal, Durban, South Africa.
| | - M Röösli
- Swiss Tropical and Public Health Institute, Basel, Switzerland.
| | - K de Hoogh
- Swiss Tropical and Public Health Institute, Basel, Switzerland.
| | - K Meliefste
- Institute for Risk Assessment Sciences, Utrecht, the Netherlands.
| | - H Tularam
- Discipline of Occupational and Environmental Health, University of KwaZulu-Natal, Durban, South Africa.
| | - A C Olin
- Department of Occupational and Environmental Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden.
| | - H K Carlsen
- Department of Occupational and Environmental Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden.
| | - G Mentz
- University Michigan, Ann Arbor, MI, USA.
| | - K Asharam
- Discipline of Occupational and Environmental Health, University of KwaZulu-Natal, Durban, South Africa.
| | - R N Naidoo
- Discipline of Occupational and Environmental Health, University of KwaZulu-Natal, Durban, South Africa.
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4
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Naumann J, Koppe N, Thome UH, Laube M, Zink M. Mechanical properties of the premature lung: From tissue deformation under load to mechanosensitivity of alveolar cells. Front Bioeng Biotechnol 2022; 10:964318. [PMID: 36185437 PMCID: PMC9523442 DOI: 10.3389/fbioe.2022.964318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 08/23/2022] [Indexed: 11/16/2022] Open
Abstract
Many preterm infants require mechanical ventilation as life-saving therapy. However, ventilation-induced overpressure can result in lung diseases. Considering the lung as a viscoelastic material, positive pressure inside the lung results in increased hydrostatic pressure and tissue compression. To elucidate the effect of positive pressure on lung tissue mechanics and cell behavior, we mimic the effect of overpressure by employing an uniaxial load onto fetal and adult rat lungs with different deformation rates. Additionally, tissue expansion during tidal breathing due to a negative intrathoracic pressure was addressed by uniaxial tension. We found a hyperelastic deformation behavior of fetal tissues under compression and tension with a remarkable strain stiffening. In contrast, adult lungs exhibited a similar response only during compression. Young’s moduli were always larger during tension compared to compression, while only during compression a strong deformation-rate dependency was found. In fact, fetal lung tissue under compression showed clear viscoelastic features even for small strains. Thus, we propose that the fetal lung is much more vulnerable during inflation by mechanical ventilation compared to normal inspiration. Electrophysiological experiments with different hydrostatic pressure gradients acting on primary fetal distal lung epithelial cells revealed that the activity of the epithelial sodium channel (ENaC) and the sodium-potassium pump (Na,K-ATPase) dropped during pressures of 30 cmH2O. Thus, pressures used during mechanical ventilation might impair alveolar fluid clearance important for normal lung function.
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Affiliation(s)
- Jonas Naumann
- Research Group Biotechnology and Biomedicine, Peter-Debye-Institute for Soft Matter Physics, Leipzig University, Leipzig, Germany
| | - Nicklas Koppe
- Research Group Biotechnology and Biomedicine, Peter-Debye-Institute for Soft Matter Physics, Leipzig University, Leipzig, Germany
| | - Ulrich H. Thome
- Center for Pediatric Research Leipzig, Department of Pediatrics, Division of Neonatology, Leipzig University, Leipzig, Germany
| | - Mandy Laube
- Center for Pediatric Research Leipzig, Department of Pediatrics, Division of Neonatology, Leipzig University, Leipzig, Germany
| | - Mareike Zink
- Research Group Biotechnology and Biomedicine, Peter-Debye-Institute for Soft Matter Physics, Leipzig University, Leipzig, Germany
- *Correspondence: Mareike Zink,
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5
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Development of Lung Function in Preterm Infants During the First Two Years of Life. Arch Bronconeumol 2022; 58:237-245. [PMID: 35312587 DOI: 10.1016/j.arbres.2021.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 06/23/2021] [Accepted: 07/18/2021] [Indexed: 11/22/2022]
Abstract
INTRODUCTION It remains unclear if prematurity itself can influence post delivery lung development and particularly, the bronchial size. AIM To assess lung function during the first two years of life in healthy preterm infants and compare the measurements to those obtained in healthy term infants during the same time period. METHODS This observational longitudinal study assessed lung function in 74 preterm (30+0 to 35+6 weeks' gestational age) and 76 healthy term control infants who were recruited between 2011 and 2013. Measurements of tidal breathing, passive respiratory mechanics, tidal and raised volume forced expirations (V'maxFRC and FEF25-75, respectively) were undertaken following administration of oral chloral hydrate sedation according to ATS/ERS recommendations at 6- and 18-months corrected age. RESULTS Lung function measurements were obtained from the preterm infants and full term controls initially at 6 months of age. Preterm infants had lower absolute and adjusted values (for gestational age, postnatal age, sex, body size, and confounding factors) for respiratory compliance and V'maxFRC. At 18 months corrected postnatal age, similar measurements were repeated in 57 preterm infants and 61 term controls. A catch-up in tidal volume, respiratory mechanics parameters, FEV0.5 and forced expiratory flows was seen in preterm infants. CONCLUSION When compared with term controls, the lower forced expiratory flows observed in the healthy preterm group at 6 months was no longer evident at 18 months corrected age, suggesting a catch-up growth of airway function.
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Sindelar R, Shepherd EG, Ågren J, Panitch HB, Abman SH, Nelin LD. Established severe BPD: is there a way out? Change of ventilatory paradigms. Pediatr Res 2021; 90:1139-1146. [PMID: 34012026 DOI: 10.1038/s41390-021-01558-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 04/12/2021] [Accepted: 04/13/2021] [Indexed: 02/04/2023]
Abstract
Improved survival of extremely preterm newborn infants has increased the number of infants at risk for developing bronchopulmonary dysplasia (BPD). Despite efforts to prevent BPD, many of these infants still develop severe BPD (sBPD) and require long-term invasive mechanical ventilation. The focus of research and clinical management has been on the prevention of BPD, which has had only modest success. On the other hand, research on the management of the established sBPD patient has received minimal attention even though this condition poses large economic and health problems with extensive morbidities and late mortality. Patients with sBPD, however, have been shown to respond to treatments focused not only on ventilatory strategies but also on multidisciplinary approaches where neurodevelopmental support, growth promoting strategies, and aggressive treatment of pulmonary hypertension improve their long-term outcomes. In this review we will try to present a physiology-based ventilatory strategy for established sBPD, emphasizing a possible paradigm shift from acute efforts to wean infants at all costs to a more chronic approach of stabilizing the infant. This chronic approach, herein referred to as chronic phase ventilation, aims at allowing active patient engagement, reducing air trapping, and improving ventilation-perfusion matching, while providing sufficient support to optimize late outcomes. IMPACT: Based on pathophysiological aspects of evolving and established severe BPD in premature infants, this review presents some lung mechanical properties of the most severe phenotype and proposes a chronic phase ventilatory strategy that aims at reducing air trapping, improving ventilation-perfusion matching and optimizing late outcomes.
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Affiliation(s)
- Richard Sindelar
- University Children's Hospital, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
| | - Edward G Shepherd
- Nationwide Children's Hospital, Ohio State University, Columbus, OH, USA
| | - Johan Ågren
- University Children's Hospital, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Howard B Panitch
- Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, USA
| | - Steven H Abman
- Children's Hospital Colorado, University of Colorado, Aurora, CO, USA
| | - Leif D Nelin
- University Children's Hospital, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.,Nationwide Children's Hospital, Ohio State University, Columbus, OH, USA
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7
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Flores-Fenlon N, Wright N, Lew C, Stavroudis TA, Wee CP, Davidson Ward SL, Bansal M. Retrospective analysis of inpatient polysomnogram characteristics and discharge outcomes in infants with bronchopulmonary dysplasia requiring home oxygen therapy. Pediatr Pulmonol 2021; 56:88-96. [PMID: 33107696 PMCID: PMC8260179 DOI: 10.1002/ppul.25129] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 10/12/2020] [Accepted: 10/13/2020] [Indexed: 02/03/2023]
Abstract
RATIONALE Little is known about the polysomnogram (PSG) characteristics in infants with bronchopulmonary dysplasia (BPD), especially severe BPD, who do not need home ventilatory support but are at increased risk for chronic hypoxia and are vulnerable to its effects. OBJECTIVE This study aims to assess PSG characteristics and change in discharge outcomes in premature infants with BPD who required oxygen therapy at discharge. METHODS This is a retrospective chart review of premature infants with BPD who were admitted to a quaternary newborn and infant intensive care unit from January 1, 2012 to December 31, 2015 and who underwent polysomnography before discharge. MEASUREMENTS AND MAIN RESULTS Data from 127 patients were analyzed. The median gestational age of our patients was 26 weeks and 1 day (interquartile range [IQR]: 24.71, 28.86). The majority of the patients had moderate-to-severe BPD. The median obstructive apnea-hypopnea index was 5.3 events/h (IQR: 2.2, 10.1). The median oxygen desaturation index was 15.7 events/h (IQR: 4.7, 35). Nadir oxygen saturation measured by pulse oximeter was 81% (IQR: 76-86) and the arousal/awakening index was 21.9 (IQR: 13.3-30.9). No statistically significant difference was noted between severe and nonsevere BPD groups for PSG characteristics. However, average end-tidal CO2 was significantly higher in the severe BPD group (p = .0438). Infants in the severe BPD group were intubated longer than infants with nonsevere BPD (p = .0082). The corrected gestational age (CGA) at the time of discharge (CGA-PSG) and PSG (CGA-DC) was higher in severe BPD patients but not statistically different. The majority of premature infants who underwent a PSG were discharged home with oxygen, and 69% required a titration of their level of support based on results from the PSG. CONCLUSION Our results highlight the presence of abnormal PSG characteristics in BPD patients, as early as 43 weeks CGA. These findings have not been previously described in this patient population prior to initial discharge from the hospital. A severe BPD phenotype tends to be associated with higher respiratory morbidity compared with a nonsevere BPD phenotype for the comparable CGA. PSG, when available, may be helpful for individualizing and streamlining treatment in preparation for discharge home and mitigating the effects of intermittent hypoxic episodes.
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Affiliation(s)
- Nicole Flores-Fenlon
- Division of Neonatology, Department of Pediatrics, LAC+USC Medical Center, Keck School of Medicine of USC, Los Angeles, California, USA
| | - Noah Wright
- Rocky Vista University College of Osteopathic Medicine, Parker, Colorado, USA
| | - Cheryl Lew
- Division of Pediatric Pulmonology and Sleep Medicine, Department of Pediatrics, Keck School of Medicine, Children's Hospital Los Angeles, University of Southern California, Los Angeles, California, USA
| | - Theodora A Stavroudis
- Division of Neonatology, Department of Pediatrics, Keck School of Medicine, Children's Hospital Los Angeles, Fetal and Neonatal Institute, University of Southern California, Los Angeles, California, USA
| | - Choo Phei Wee
- Southern California Clinical and Translational Science Institute (SC-CTSI), The Saban Research Institute (TSRI) Biostatistics Core, Children's Hospital Los Angeles, Los Angeles, California, USA
| | - Sally L Davidson Ward
- Division of Pediatric Pulmonology and Sleep Medicine, Department of Pediatrics, Keck School of Medicine, Children's Hospital Los Angeles, University of Southern California, Los Angeles, California, USA
| | - Manvi Bansal
- Division of Pediatric Pulmonology and Sleep Medicine, Department of Pediatrics, Keck School of Medicine, Children's Hospital Los Angeles, University of Southern California, Los Angeles, California, USA
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8
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Ericson JE, McGuire J, Michaels MG, Schwarz A, Frenck R, Deville JG, Agarwal S, Bressler AM, Gao J, Spears T, Benjamin DK, Smith PB, Bradley JS. Hospital-acquired Pneumonia and Ventilator-associated Pneumonia in Children: A Prospective Natural History and Case-Control Study. Pediatr Infect Dis J 2020; 39:658-664. [PMID: 32150005 PMCID: PMC8293907 DOI: 10.1097/inf.0000000000002642] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND Clinical trials for antibiotics designed to treat hospital-acquired and ventilator-associated bacterial pneumonias (HABP/VABP) are hampered by making these diagnoses in a way that is acceptable to the United States Food and Drug Administration and consistent with standards of care. We examined laboratory and clinical features that might improve pediatric HABP/VABP trial efficiency by identifying risk factors predisposing children to HABP/VABP and describing the epidemiology of pediatric HABP/VABP. METHODS We prospectively reviewed the electronic medical records of patients <18 years of age admitted to intensive and intermediate care units (ICUs) if they received qualifying respiratory support or were started on antibiotics for a lower respiratory tract infection or undifferentiated sepsis. Subjects were followed until HABP/VABP was diagnosed or they were discharged from the ICU. Clinical, laboratory and imaging data were abstracted using structured chart review. We calculated HABP/VABP incidence and used a stepwise backward selection multivariable model to identify risk factors associated with development of HABP/VABP. RESULTS A total of 862 neonates, infants and children were evaluated for development of HABP/VABP; 10% (82/800) of those receiving respiratory support and 12% (103/862) overall developed HABP/VABP. Increasing age, shorter height/length, longer ICU length of stay, aspiration risk, blood product transfusion in the prior 7 days and frequent suctioning were associated with increased odds of HABP/VABP. The use of noninvasive ventilation and gastric acid suppression were both associated with decreased odds of HABP/VABP. CONCLUSIONS Food and Drug Administration-defined HABP/VABP occurred in 10%-12% of pediatric patients admitted to ICUs. Risk factors vary by age group.
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Affiliation(s)
| | | | | | - Adam Schwarz
- Children’s Hospital of Orange County, Orange, CA, USA
| | - Robert Frenck
- Cincinnati Children’s Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | | | | | | | - Jamie Gao
- Duke Clinical Research Institute, Durham, NC, USA
| | - Tracy Spears
- Duke Clinical Research Institute, Durham, NC, USA
| | - Daniel K. Benjamin
- Duke Clinical Research Institute, Durham, NC, USA
- Duke University Medical Center, Durham, NC USA
| | - P. Brian Smith
- Duke Clinical Research Institute, Durham, NC, USA
- Duke University Medical Center, Durham, NC USA
| | - John S. Bradley
- University of California, San Diego School of Medicine and Rady Children’s Hospital San Diego, San Diego, CA USA
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9
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Ring AM, Carlens J, Bush A, Castillo-Corullón S, Fasola S, Gaboli MP, Griese M, Koucky V, La Grutta S, Lombardi E, Proesmans M, Schwerk N, Snijders D, Nielsen KG, Buchvald F. Pulmonary function testing in children's interstitial lung disease. Eur Respir Rev 2020; 29:29/157/200019. [PMID: 32699025 DOI: 10.1183/16000617.0019-2020] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 04/11/2020] [Indexed: 12/17/2022] Open
Abstract
The use of pulmonary function tests (PFTs) has been widely described in airway diseases like asthma and cystic fibrosis, but for children's interstitial lung disease (chILD), which encompasses a broad spectrum of pathologies, the usefulness of PFTs is still undetermined, despite widespread use in adult interstitial lung disease. A literature review was initiated by the COST/Enter chILD working group aiming to describe published studies, to identify gaps in knowledge and to propose future research goals in regard to spirometry, whole-body plethysmography, infant and pre-school PFTs, measurement of diffusing capacity, multiple breath washout and cardiopulmonary exercise tests in chILD. The search revealed a limited number of papers published in the past three decades, of which the majority were descriptive and did not report pulmonary function as the main outcome.PFTs may be useful in different stages of management of children with suspected or confirmed chILD, but the chILD spectrum is diverse and includes a heterogeneous patient group in all ages. Research studies in well-defined patient cohorts are needed to establish which PFT and outcomes are most relevant for diagnosis, evaluation of disease severity and course, and monitoring individual conditions both for improvement in clinical care and as end-points in future randomised controlled trials.
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Affiliation(s)
- Astrid Madsen Ring
- Paediatric Pulmonary Service, Dept of Paediatrics and Adolescent Medicine, Copenhagen University Hospital, Rigshospitalet, Danish PCD & chILD Centre, CF Centre Copenhagen, Copenhagen, Denmark.,Joint first authors
| | - Julia Carlens
- Clinic for Paediatric Pneumology, Allergology and Neonatology, Medizinische Hochschule Hannover Zentrum fur Kinderheilkunde und Jugendmedizin, Hannover, Germany.,Joint first authors
| | - Andy Bush
- Paediatrics and Paediatric Respiratory Medicine, Imperial College London, London, UK.,Paediatric Respiratory Medicine, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Silvia Castillo-Corullón
- Unidad de Neumología infantil y Fibrosis quística, Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - Salvatore Fasola
- Institute of Biomedical Research and Innovation, National Research Council of Italy, Palermo, Italy
| | - Mirella Piera Gaboli
- Neumologia Infantil y Unidad de Cuidados Intensivos Pediatricos, Hospital Universitario Salamanca, Salamanca, Spain
| | - Matthias Griese
- University Hospital of Munich, Dr. von Hauner Children's Hospital, German Center for Lung Research (DZL), Munich, Germany
| | - Vaclav Koucky
- Dept of Paediatrics, Univerzita Karlova v Praze 2 lekarska fakulta, Prague, Czech Republic
| | - Stefania La Grutta
- Institute of Biomedical Research and Innovation, National Research Council of Italy, Palermo, Italy
| | - Enrico Lombardi
- Pediatric Pulmonary Unit, Anna Meyer Pediatric University-Hospital, Florence, Italy
| | | | - Nicolaus Schwerk
- Clinic for Paediatric Pneumology, Allergology and Neonatology, Medizinische Hochschule Hannover Zentrum fur Kinderheilkunde und Jugendmedizin, Hannover, Germany
| | | | - Kim Gjerum Nielsen
- Paediatric Pulmonary Service, Dept of Paediatrics and Adolescent Medicine, Copenhagen University Hospital, Rigshospitalet, Danish PCD & chILD Centre, CF Centre Copenhagen, Copenhagen, Denmark.,Joint last authors
| | - Frederik Buchvald
- Paediatric Pulmonary Service, Dept of Paediatrics and Adolescent Medicine, Copenhagen University Hospital, Rigshospitalet, Danish PCD & chILD Centre, CF Centre Copenhagen, Copenhagen, Denmark .,Joint last authors
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10
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Friedlander Y, Zanette B, Lindenmaier A, Sadanand S, Li D, Stirrat E, Couch M, Kassner A, Jankov RP, Santyr G. Chemical shift of
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Xe dissolved in red blood cells: Application to a rat model of bronchopulmonary dysplasia. Magn Reson Med 2019; 84:52-60. [DOI: 10.1002/mrm.28121] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 11/13/2019] [Accepted: 11/19/2019] [Indexed: 12/23/2022]
Affiliation(s)
- Yonni Friedlander
- Translational Medicine Program Hospital for Sick Children Toronto Ontario Canada
- Department of Medical Biophysics University of Toronto Toronto Ontario Canada
| | - Brandon Zanette
- Translational Medicine Program Hospital for Sick Children Toronto Ontario Canada
| | - Andras Lindenmaier
- Translational Medicine Program Hospital for Sick Children Toronto Ontario Canada
- Department of Medical Biophysics University of Toronto Toronto Ontario Canada
| | - Siddharth Sadanand
- Translational Medicine Program Hospital for Sick Children Toronto Ontario Canada
| | - Daniel Li
- Translational Medicine Program Hospital for Sick Children Toronto Ontario Canada
| | - Elaine Stirrat
- Translational Medicine Program Hospital for Sick Children Toronto Ontario Canada
| | - Marcus Couch
- Translational Medicine Program Hospital for Sick Children Toronto Ontario Canada
- Department of Medical Biophysics University of Toronto Toronto Ontario Canada
| | - Andrea Kassner
- Translational Medicine Program Hospital for Sick Children Toronto Ontario Canada
- Department of Medical Imaging University of Toronto Toronto Ontario Canada
| | - Robert P. Jankov
- Molecular Biomedicine Program Children’s Hospital of Eastern Ontario Research Institute Ottawa Ontario Canada
- Department of Cellular and Molecular Medicine University of Ottawa Ottawa Ontario Canada
| | - Giles Santyr
- Translational Medicine Program Hospital for Sick Children Toronto Ontario Canada
- Department of Medical Biophysics University of Toronto Toronto Ontario Canada
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Oscillatory respiratory mechanics on the first day of life improves prediction of respiratory outcomes in extremely preterm newborns. Pediatr Res 2019; 85:312-317. [PMID: 30127523 DOI: 10.1038/s41390-018-0133-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Revised: 06/19/2018] [Accepted: 07/18/2018] [Indexed: 11/09/2022]
Abstract
BACKGROUND We aimed to evaluate if lung mechanics measured by forced oscillatory technique (FOT) during the first day of life help identify extremely low gestational age newborns (ELGANs) at risk of prolonged mechanical ventilation (MV) and oxygen dependency. METHODS Positive end-expiratory pressure (PEEP) was increased 2 cmH2O above the clinically set PEEP, then decreased by four 5-min steps of 1 cmH2O, and restored at the clinical value. At each PEEP, FOT measurements were performed bedside during MV. Changes in respiratory mechanics with PEEP, clinical parameters, and chest radiographs were evaluated. RESULTS Twenty-two newborns (24+4 ± 1+4 wks gestational age (GA); birth weight 653 ± 166 g) on assist/control ventilation were studied. Infants were ventilated for 40 ± 36 d (range 1-155 d), 11 developed severe bronchopulmonary dysplasia (BPD) and one died before 28 d. Early lung mechanics correlated with days on MV, days of respiratory support, and BPD grade. Effects of increasing PEEP on oscillatory reactance assessed by FOT together with GA and radiographic score predicted days on MV (multilinear model, r2 = 0.73). A logistic model considering the same FOT parameter together with GA predicts BPD development. CONCLUSIONS FOT can be applied bedside in ELGANs, where early changes in lung mechanics with PEEP improve clinical prediction of respiratory outcomes.
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Pavord ID, Beasley R, Agusti A, Anderson GP, Bel E, Brusselle G, Cullinan P, Custovic A, Ducharme FM, Fahy JV, Frey U, Gibson P, Heaney LG, Holt PG, Humbert M, Lloyd CM, Marks G, Martinez FD, Sly PD, von Mutius E, Wenzel S, Zar HJ, Bush A. After asthma: redefining airways diseases. Lancet 2018; 391:350-400. [PMID: 28911920 DOI: 10.1016/s0140-6736(17)30879-6] [Citation(s) in RCA: 674] [Impact Index Per Article: 112.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Revised: 02/26/2017] [Accepted: 03/07/2017] [Indexed: 12/15/2022]
Affiliation(s)
- Ian D Pavord
- Respiratory Medicine Unit, Nuffield Department of Medicine and NIHR Oxford Biomedical Research Centre, University of Oxford, UK.
| | - Richard Beasley
- Medical Research Institute of New Zealand, Wellington, New Zealand
| | - Alvar Agusti
- Respiratory Institute, Hospital Clinic, IDIBAPS, University of Barcelona, Barcelona, Spain; CIBER Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Gary P Anderson
- Lung Health Research Centre, University of Melbourne, Melbourne, VIC, Australia
| | - Elisabeth Bel
- Department of Respiratory Medicine, Academic Medical Center, University of Amsterdam, Netherlands
| | - Guy Brusselle
- Department of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium; Departments of Epidemiology and Respiratory Medicine, Erasmus Medical Center, Rotterdam, Netherlands
| | - Paul Cullinan
- National Heart and Lung Institute, Imperial College, London, UK
| | | | - Francine M Ducharme
- Departments of Paediatrics and Social and Preventive Medicine, University of Montreal, Montreal, QC, Canada
| | - John V Fahy
- Cardiovascular Research Institute, and Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Urs Frey
- University Children's Hospital Basel, University of Basel, Basel, Switzerland
| | - Peter Gibson
- Department of Respiratory and Sleep Medicine, John Hunter Hospital, Hunter Medical Research Institute, Newcastle, NSW, Australia; Priority Research Centre for Asthma and Respiratory Disease, The University of Newcastle, Newcastle, NSW, Australia
| | - Liam G Heaney
- Centre for Experimental Medicine, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK
| | - Patrick G Holt
- Telethon Kids Institute, University of Western Australia, Perth, WA, Australia
| | - Marc Humbert
- L'Université Paris-Sud, Faculté de Médecine, Université Paris-Saclay, Paris, France; Service de Pneumologie, Hôpital Bicêtre, Paris, France; INSERM UMR-S 999, Hôpital Marie Lannelongue, Paris, France
| | - Clare M Lloyd
- National Heart and Lung Institute, Imperial College, London, UK
| | - Guy Marks
- Department of Respiratory Medicine, South Western Sydney Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - Fernando D Martinez
- Asthma and Airway Disease Research Center, The University of Arizona, Tuscon, AZ, USA
| | - Peter D Sly
- Department of Children's Health and Environment, Children's Health Queensland, Brisbane, QLD, Australia; Centre for Children's Health Research, Brisbane, QLD, Australia
| | - Erika von Mutius
- Dr. von Haunersches Kinderspital, Ludwig Maximilians Universität, Munich, Germany
| | - Sally Wenzel
- University of Pittsburgh Asthma Institute, University of Pittsburgh, Pittsburgh, PA, USA
| | - Heather J Zar
- Department of Paediatrics and Child Health, Red Cross Children's Hospital and Medical Research Council Unit on Child and Adolescent Health, University of Cape Town, Cape Town, South Africa
| | - Andy Bush
- Department of Paediatrics, Imperial College, London, UK; Department of Paediatric Respiratory Medicine, Imperial College, London, UK
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Abstract
OBJECTIVE This study sought to validate pediatric models with normal and altered pulmonary mechanics. METHODS PubMed and CINAHL databases were searched for studies directly measuring pulmonary mechanics of healthy infants and children, infants with severe bronchopulmonary dysplasia and neuromuscular disease. The ASL 5000 was used to construct models using tidal volume (VT), inspiratory time (TI), respiratory rate, resistance, compliance, and esophageal pressure gleaned from literature. Data were collected for a 1-minute period and repeated three times for each model. t tests compared modeled data with data abstracted from the literature. Repeated measures analyses evaluated model performance over multiple iterations. Statistical significance was established at a P value of less than 0.05. RESULTS Maximum differences of means (experimental iteration mean - clinical standard mean) for TI and VT are the following: term infant without lung disease (TI = 0.09 s, VT = 0.29 mL), severe bronchopulmonary dysplasia (TI = 0.08 s, VT = 0.17 mL), child without lung disease (TI = 0.10 s, VT = 0.17 mL), and child with neuromuscular disease (TI = 0.09 s, VT = 0.57 mL). One-sample testing demonstrated statistically significant differences between clinical controls and VT and TI values produced by the ASL 5000 for each iteration and model (P < 0.01). The greatest magnitude of differences was negligible (VT < 1.6%, TI = 18%) and not clinically relevant. CONCLUSIONS Inconsistencies occurred with the models constructed on the ASL 5000. It was deemed accurate for the study purposes. It is therefore essential to test models and evaluate magnitude of differences before use.
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Kaczmarczyk K, Wiszomirska I, Szturmowicz M, Magiera A, Błażkiewicz M. Are preterm-born survivors at risk of long-term respiratory disease? Ther Adv Respir Dis 2017; 11:277-287. [PMID: 28614994 PMCID: PMC5933633 DOI: 10.1177/1753465817710595] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Accepted: 04/21/2017] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND To evaluate the long-term impact of preterm birth on respiratory function in female patients born preterm, we undertook spirometric examinations twice, as they reached the age of puberty, then follow-up examinations of part of the same cohort in adulthood. We sought evidence that preterm birth is correlated with poorer spirometric results into adulthood. METHODS A total of 70 girls (aged 12.2 ± 1.5 years in 1997) who had been born preterm (at 34.7 ± 1.86 weeks, none having experienced bronchopulmonary dysplasia) took part in spriometric examinations in 1997 and again in 1998. Of those, after a gap of 17 years, a group of 12 were successfully recontacted and participated in the 2015 examination as adults (then aged 27.6 ± 2.6 years, born at 34.5 ± 1.92 weeks). We compared spirometric results across the adolescent and adult examinations, and compared the adult results with an adult reference group. RESULTS The percentage values of FEV1 (forced expiratory volume in 1 s), FVC (forced vital capacity) and MVV (maximal voluntary ventilation) showed significant improvement between the two examinations in the early adolescent period. In adulthood, FEV1%pred (percentage predicted forced expiratory volume in 1 s) showed no statistically significant difference. The mean values of both FVC and FVC%pred (percentage predicted forced vital capacity) for the preterm-born group were lower than for the reference group, but this was not statistically significant. The preterm-born group showed lower values of such parameters as forced expiratory flow at 25-75% of FVC, MEF25 (maximal expiratory flow at 25% of forced vital capacity) and FEV1/FVC as compared with the reference group, but again without statistical significance. CONCLUSIONS (1) A somewhat below-norm level of respiratory parameters among preterm-born girls entering pubescence may attest to continued negative impact on their respiratory system. (2) A significant improvement in their spirometric results 1 year later may indicate that pubescence helps compensate for the earlier negative effect of preterm birth. (3) No significant differences were seen in lung function in preterm-born adults as compared with a reference group of adults, although the preterm-born group did exhibit lower values of all parameters studied and more frequent obstructive disorders.
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Affiliation(s)
- Katarzyna Kaczmarczyk
- Head of Physiology Department, Faculty of
Rehabilitation, Józef Piłsudski University of Physical Education in Warsaw,
Marymoncka 34 Street, Warsaw, Poland
| | - Ida Wiszomirska
- Józef Piłsudski University of Physical Education
in Warsaw, Faculty of Rehabilitation, Warsaw, Poland
| | - Magdalena Szturmowicz
- Józef Piłsudski University of Physical Education
in Warsaw, Faculty of Rehabilitation, Warsaw, Poland
| | - Andrzej Magiera
- Józef Piłsudski University of Physical Education
in Warsaw, Faculty of Rehabilitation, Warsaw, Poland
| | - Michalina Błażkiewicz
- Józef Piłsudski University of Physical Education
in Warsaw, Faculty of Rehabilitation, Warsaw, Poland
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15
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De Luca D, Costa R, Visconti F, Piastra M, Conti G. Oscillation transmission and volume delivery during face mask-delivered HFOV in infants: Bench and in vivo study. Pediatr Pulmonol 2016; 51:705-12. [PMID: 26918535 DOI: 10.1002/ppul.23403] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Revised: 01/06/2016] [Accepted: 01/21/2016] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Noninvasive high frequency oscillatory ventilation (NHFOV) has not been studied beyond neonatal age and with interfaces other than nasal prongs. We set up a preliminary study to investigate feasibility, oscillation transmission, and volume delivery of face mask-delivered NHFOV in a bench model mimicking a normal 1-year infant without any lung disease and then in vivo in a series of infants with same characteristics. DESIGN A mannequin with upper airways was connected to an electronic active lung simulator ventilated through NHFOV with varying parameters. Volume delivered by oscillations (oTv), oscillatory pressure ratio, and estimation of ventilation (DCO2) were measured at the lung simulator. Four infants were ventilated with face mask-delivered NHFOV for 2 hr and monitored with respiratory inductance plethismography. Vital parameters, oscillatory pressure ratio, oscillatory (RIPo), and spontaneous cage/abdomen displacement (RIPs) were recorded. RESULTS There was a dampening of oscillation amplitude both on the bench model and in vivo: oscillatory pressure ratios at the mask were 80% and 17%, respectively. Significant correlations exist between oscillatory pressure ratio (only when this latter was <0.038) and oTv (r = 0.48; P < 0.001) or DCO2 (r = 0.47; P < 0.001). At multivariate analysis, oscillatory pressure ratio was a main determinant of oTv and DCO2. Oscillations were slightly visible on the chest in vivo and RIPo was about 5% of RIPs. NHFOV did not change vital parameters and did not cause discomfort. CONCLUSIONS Face mask-delivered NHFOV is feasible in a model of 1-year infant. No major complications occurred in vivo. Oscillations are superimposed to the spontaneous breathing and are significantly dampened. Pediatr Pulmonol. Pediatr Pulmonol. 2016;51:705-712. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Daniele De Luca
- Pediatric Intensive Care Unit, Department of Anesthesia and Intensive Care, University Hospital "A.Gemelli", Catholic University of the Sacred Heart, Rome, Italy.,Division of Pediatrics and Neonatal Critical Care, South Paris University Hospitals, "A.Béclère" Medical Center-APHP, Paris, France
| | - Roberta Costa
- VentiLab, Department of Anesthesia and Intensive Care, University Hospital "A.Gemelli", Catholic University of the Sacred Heart, Rome, Italy
| | - Federico Visconti
- Pediatric Intensive Care Unit, Department of Anesthesia and Intensive Care, University Hospital "A.Gemelli", Catholic University of the Sacred Heart, Rome, Italy
| | - Marco Piastra
- Pediatric Intensive Care Unit, Department of Anesthesia and Intensive Care, University Hospital "A.Gemelli", Catholic University of the Sacred Heart, Rome, Italy
| | - Giorgio Conti
- Pediatric Intensive Care Unit, Department of Anesthesia and Intensive Care, University Hospital "A.Gemelli", Catholic University of the Sacred Heart, Rome, Italy.,VentiLab, Department of Anesthesia and Intensive Care, University Hospital "A.Gemelli", Catholic University of the Sacred Heart, Rome, Italy
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Abstract
Brochopulmonary dysplasia (BPD) is the most common form of chronic lung disease in infancy. At present, BPD primarily occurs in extremely premature infants (23-28 weeks of gestation) born during the late canalicular/early saccular stage of lung development. This article summarizes the current knowledge of the life course of BPD by emphasizing recent or key articles notating its natural history from the newborn period through adulthood and building the case for a continued focus on its primary prevention.
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Affiliation(s)
- Cindy T McEvoy
- Department of Pediatrics, Oregon Health & Science University, 707 SW Gaines Street, CDRC-P, Portland, OR 97239-3098, USA.
| | - Judy L Aschner
- Department of Pediatrics, Children's Hospital at Montefiore, Albert Einstein College of Medicine, Rosenthal Pavilion, Room 402, 111 East 210th Street, Bronx, NY 10467, USA; Department of Obstetrics & Gynecology and Women's Health, Children's Hospital at Montefiore, Albert Einstein College of Medicine, Rosenthal Pavilion, Room 402, 111 East 210th Street, Bronx, NY 10467, USA
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Reiterer F, Sivieri E, Abbasi S. Evaluation of bedside pulmonary function in the neonate: From the past to the future. Pediatr Pulmonol 2015; 50:1039-50. [PMID: 26139200 DOI: 10.1002/ppul.23245] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Revised: 04/01/2015] [Accepted: 05/08/2015] [Indexed: 01/10/2023]
Abstract
Pulmonary function testing and monitoring plays an important role in the respiratory management of neonates. A noninvasive and complete bedside evaluation of the respiratory status is especially useful in critically ill neonates to assess disease severity and resolution and the response to pharmacological interventions as well as to guide mechanical respiratory support. Besides traditional tools to assess pulmonary gas exchage such as arterial or transcutaenous blood gas analysis, pulse oximetry, and capnography, additional valuable information about global lung function is provided through measurement of pulmonary mechanics and volumes. This has now been aided by commercially available computerized pulmonary function testing systems, respiratory monitors, and modern ventilators with integrated pulmonary function readouts. In an attempt to apply easy-to-use pulmonary function testing methods which do not interfere with the infant́s airflow, other tools have been developed such as respiratory inductance plethysmography, and more recently, electromagnetic and optoelectronic plethysmography, electrical impedance tomography, and electrical impedance segmentography. These alternative technologies allow not only global, but also regional and dynamic evaluations of lung ventilation. Although these methods have proven their usefulness for research applications, they are not yet broadly used in a routine clinical setting. This review will give a historical and clinical overview of different bedside methods to assess and monitor pulmonary function and evaluate the potential clinical usefulness of such methods with an outlook into future directions in neonatal respiratory diagnostics.
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Affiliation(s)
- F Reiterer
- Division of Neonatology, Department of Pediatrics and Adolescence Medicine, Medical University Graz, Graz, Austria
| | - E Sivieri
- Section on Newborn Pediatrics, Pennsylvania Hospital, Philadelphia, Pennsylvania.,Division of Neonatology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - S Abbasi
- Section on Newborn Pediatrics, Pennsylvania Hospital, Philadelphia, Pennsylvania.,Division of Neonatology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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18
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Barikbin P, Roehr CC, Wilitzki S, Kalache K, Degenhardt P, Bührer C, Schmalisch G. Postnatal Lung Function in Congenital Cystic Adenomatoid Malformation of the Lung. Ann Thorac Surg 2015; 99:1164-9. [DOI: 10.1016/j.athoracsur.2014.11.018] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2014] [Revised: 10/29/2014] [Accepted: 11/17/2014] [Indexed: 12/29/2022]
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Gray D, Czövek D, Smith E, Willemse L, Alberts A, Gingl Z, Hall GL, Zar HJ, Sly PD, Hantos Z. Respiratory impedance in healthy unsedated South African infants: effects of maternal smoking. Respirology 2015; 20:467-73. [PMID: 25581268 PMCID: PMC4670479 DOI: 10.1111/resp.12463] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2014] [Revised: 09/17/2014] [Accepted: 11/04/2014] [Indexed: 01/16/2023]
Abstract
Background and objective Non-invasive techniques for measuring lung mechanics in infants are needed for a better understanding of lung growth and function, and to study the effects of prenatal factors on subsequent lung growth in healthy infants. The forced oscillation technique requires minimal cooperation from the individual but has rarely been used in infants. The study aims to assess the use of the forced oscillation technique to measure the influence of antenatal exposures on respiratory mechanics in unsedated infants enrolled in a birth cohort study in Cape Town, South Africa. Methods Healthy term infants were studied at 6–10 weeks of age using the forced oscillation technique. Respiratory impedance was measured in the frequency range 8–48 Hz via a face mask during natural sleep. Respiratory system resistance, compliance and inertance were calculated from the impedance spectra. Results Of 177 infants tested, successful measurements were obtained in 164 (93%). Median (25–75%) values for resistance, compliance and inertance were 50.2 (39.5–60.6) cmH2O.s.L−1, 0.78 (0.61–0.99) mL.cmH2O−1 and 0.062 (0.050–0.086) cmH2O.s2.L−1, respectively. As a group, male infants had 16% higher resistance (P = 0.006) and 18% lower compliance (P = 0.02) than females. Infants whose mothers smoked during pregnancy had a 19% lower compliance than infants not exposed to tobacco smoke during pregnancy (P = 0.005). Neither maternal HIV infection nor ethnicity had a significant effect on respiratory mechanics. Conclusions The forced oscillation technique is sensitive enough to demonstrate the effects of tobacco smoke exposure and sex in respiratory mechanics in healthy infants. This technique will facilitate assessing perinatal influences of lung function in infancy.
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Affiliation(s)
- Diane Gray
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa
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Hutchison AA, Leclerc F, Nève V, Pillow JJ, Robinson PD. The Respiratory System. PEDIATRIC AND NEONATAL MECHANICAL VENTILATION 2015. [PMCID: PMC7193717 DOI: 10.1007/978-3-642-01219-8_4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
This chapter addresses upper airway physiology for the pediatric intensivist, focusing on functions that affect ventilation, with an emphasis on laryngeal physiology and control in breathing. Effective control of breathing ensures that the airway is protected, maintains volume homeostasis, and provides ventilation. Upper airway structures are effectors for all of these functions that affect the entire airway. Nasal functions include air conditioning and protective reflexes that can be exaggerated and involve circulatory changes. Oral cavity and pharyngeal patency enable airflow and feeding, but during sleep pharyngeal closure can result in apnea. Coordination of breathing with sucking and nutritive swallowing alters during development, while nonnutritive swallowing at all ages limits aspiration. Laryngeal functions in breathing include protection of the subglottic airway, active maintenance of its absolute volume, and control of tidal flow patterns. These are vital functions for normal lung growth in fetal life and during rapid adaptations to breathing challenges from birth through adulthood. Active central control of breathing focuses on the coordination of laryngeal and diaphragmatic activities, which adapts according to the integration of central and peripheral inputs. For the intensivist, knowledge of upper airway physiology can be applied to improve respiratory support. In a second part the mechanical properties of the respiratory system as a critical component of the chain of events that result in translation of the output of the respiratory rhythm generator to ventilation are described. A comprehensive understanding of respiratory mechanics is essential to the delivery of optimized and individualized mechanical ventilation. The basic elements of respiratory mechanics will be described and developmental changes in the airways, lungs, and chest wall that impact on measurement of respiratory mechanics with advancing postnatal age are reviewed. This will be follwowed by two sections, the first on respiratory mechanics in various neonatal pathologies and the second in pediatric pathologies. The latter can be classified in three categories. First, restrictive diseases may be of pulmonary origin, such as chronic interstitial lung diseases or acute lung injury/acute respiratory distress syndrome, which are usually associated with reduced lung compliance. Restrictive diseases may also be due to chest wall abnormalities such as obesity or scoliosis (idiopathic or secondary to neuromuscular diseases), which are associated with a reduction in chest wall compliance. Second, obstructive diseases are represented by asthma and wheezing disorders, cystic fibrosis, long term sequelae of neonatal lung disease and bronchiolitis obliterans following hematopoietic stem cell transplantation. Obstructive diseases are defined by a reduced FEV1/VC ratio. Third, neuromuscular diseases, mainly represented by DMD and SMA, are associated with a decrease in vital capacity linked to respiratory muscle weakness that is better detected by PImax, PEmax and SNIP measurements.
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Hjalmarson O, Brynjarsson H, Nilsson S, Sandberg KL. Persisting hypoxaemia is an insufficient measure of adverse lung function in very immature infants. Arch Dis Child Fetal Neonatal Ed 2014; 99:F257-62. [PMID: 24356176 DOI: 10.1136/archdischild-2013-304625] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Bronchopulmonary dysplasia (BPD), defined as protracted neonatal hypoxaemia, is considered a risk factor for respiratory disease in adulthood. The relationship between this diagnosis and the actual lung injury appearing in very immature infants is, however, unknown. OBJECTIVES To compare lung function at term in very immature infants and full-term infants, and to determine how degree and duration of neonatal hypoxaemia are related to other aspects of lung function. DESIGN AND METHODS All surviving, consecutive infants with gestational age below 28 weeks from a geographically defined area were eligible. The alveolar-arterial oxygen pressure difference was assessed as a measure of oxygenation failure. At term, functional residual capacity and gas-mixing efficiency were measured by multiple-breath nitrogen washout, and compliance and conductance of the respiratory system by the occlusion method. The results were compared to those in 50 full-term controls. MAIN RESULTS Thirty-seven of 46 eligible infants were included. The preterm infants differed markedly from the full-term infants in all lung functions tested. Infants diagnosed as having BPD had more compromised lung function than those without, but the latter group differed markedly from the full-term group in functional residual capacity, compliance and gas-mixing efficiency. Only the mechanical variables were correlated to hypoxaemia at 36 weeks postmenstrual age (PMA). CONCLUSIONS Infants with gestational age below 28 weeks at birth have remarkably impaired lung function at term, regardless of whether they carry the diagnosis BPD or not. All very immature infants may be at risk of future respiratory disease and should be monitored appropriately.
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Work of breathing indices in infants with respiratory insufficiency receiving high-flow nasal cannula and nasal continuous positive airway pressure. J Perinatol 2014; 34:27-32. [PMID: 24071905 PMCID: PMC4141486 DOI: 10.1038/jp.2013.120] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2013] [Revised: 08/12/2013] [Accepted: 08/21/2013] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To compare work of breathing (WOB) indices between two nCPAP settings and two levels of HFNC in a crossover study. STUDY DESIGN Infants with a CGA 28-40 weeks, baseline of HFNC 3-5 lpm or nCPAP 5-6 cmH2O and fraction of inspired oxygen ≤40% were eligible. WOB was analyzed using respiratory inductive plethysmography (RIP) for each of the four modalities: HFNC 3 and 5 lpm, nCPAP 5 and 6 cmH2O. N=20; Study weight 1516 g (±40 g). RESULT Approximately 12,000 breaths were analyzed indicating a high degree of asynchronous breathing and elevated WOB indices at all four levels of support. Phase angle values (means) (P<0.01): HFNC 3 lpm (114.7°), HFNC 5 lpm (96.7°), nCPAP 5 cmH2O (87.2°), nCPAP 6 cmH2O (80.5°). The mean phase relation of total breath (PhRTB) (means) (P<0.01): HFNC 3 lpm (63.2%), HFNC 5 lpm (55.3%), nCPAP 5 cmH2O (49.3%), nCPAP 6 cmH2O (48.0%). The relative labored breathing index (LBI) (means) (P≤0.001): HFNC 3 lpm (1.39), HFNC 5 lpm (1.31), nCPAP 5 cmH2O (1.29), nCPAP 6 cmH2O (1.26). Eighty-two percent of the study subjects-respiratory mode combinations displayed clustering, in which a proportion of breaths either occurred predominantly out-of-phase (relative asynchrony) or in-phase (relative synchrony). CONCLUSION In this study, WOB indices were statistically different, yet clinically similar in that they were elevated with respect to normal values. These infants with mild-to-moderate respiratory insufficiency demonstrate a meaningful elevation in WOB indices and continue to require non-invasive respiratory support. Patient variability exists with regard to biphasic clustered breathing patterns and the level of supplemental fraction of inspired oxygen ≤40% alone does not provide guidance to the optimal matching of WOB indices and non-invasive respiratory support.
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Bates JHT, Irvin CG, Farré R, Hantos Z. Oscillation mechanics of the respiratory system. Compr Physiol 2013; 1:1233-72. [PMID: 23733641 DOI: 10.1002/cphy.c100058] [Citation(s) in RCA: 118] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The mechanical impedance of the respiratory system defines the pressure profile required to drive a unit of oscillatory flow into the lungs. Impedance is a function of oscillation frequency, and is measured using the forced oscillation technique. Digital signal processing methods, most notably the Fourier transform, are used to calculate impedance from measured oscillatory pressures and flows. Impedance is a complex function of frequency, having both real and imaginary parts that vary with frequency in ways that can be used empirically to distinguish normal lung function from a variety of different pathologies. The most useful diagnostic information is gained when anatomically based mathematical models are fit to measurements of impedance. The simplest such model consists of a single flow-resistive conduit connecting to a single elastic compartment. Models of greater complexity may have two or more compartments, and provide more accurate fits to impedance measurements over a variety of different frequency ranges. The model that currently enjoys the widest application in studies of animal models of lung disease consists of a single airway serving an alveolar compartment comprising tissue with a constant-phase impedance. This model has been shown to fit very accurately to a wide range of impedance data, yet contains only four free parameters, and as such is highly parsimonious. The measurement of impedance in human patients is also now rapidly gaining acceptance, and promises to provide a more comprehensible assessment of lung function than parameters derived from conventional spirometry.
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Affiliation(s)
- Jason H T Bates
- Vermont Lung Center, University of Vermont College of Medicine, Burlington, Vermont, USA.
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Vrijlandt EJLE, Kerstjens JM, Duiverman EJ, Bos AF, Reijneveld SA. Moderately preterm children have more respiratory problems during their first 5 years of life than children born full term. Am J Respir Crit Care Med 2013; 187:1234-40. [PMID: 23525931 DOI: 10.1164/rccm.201211-2070oc] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
RATIONALE Pulmonary outcomes of moderate-preterm children (MP) are unknown. OBJECTIVES To investigate the prevalence of respiratory symptoms during infancy and at preschool age of MP compared with full-term (FT) and early preterm children (EP) and to determine factors associated with respiratory symptoms of MP at school age. METHODS Prospective cohort study. OUTCOME VARIABLES number of rehospitalizations caused by respiratory problems, prevalence of respiratory symptoms determined by ISAAC Questionnaires, and factors associated with respiratory symptoms determined by univariate and multivariate analyzes. MEASUREMENTS AND MAIN RESULTS A total of 988 MP, 551 EP, and 573 FT children were included. The number of hospitalizations caused by respiratory problems during the first year of life was doubled in MP compared with FT (6% vs. 3%; P < 0.001). At preschool age, compared with FT, MP reported more cough or wheeze during a cold (63% vs. 50%; P < 0.001); cough or wheeze without a cold (23% vs. 15%; P = 0.001); nocturnal cough (33% vs. 26%; P = 0.005); dyspnea (8% vs. 4%; P = 0.011); and use of medication (inhaled steroids, 9% vs. 6%; P = 0.042) (antibiotics, 12% vs. 7%; P = 0.002). Factors associated with respiratory symptoms at 5 years among MP were respiratory problems, eczema, rehospitalization in infancy, passive smoking in infancy, family history of asthma, and higher social class. Multivariate analyzes showed the same results except for rehospitalization in infancy. CONCLUSIONS MP have more respiratory symptoms than FT during early childhood. Factors associated with respiratory symptoms at school age are early respiratory problems, family history of asthma, higher social class, and passive smoking.
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Affiliation(s)
- Elianne J L E Vrijlandt
- Division of Pulmonology and Allergology, Department of Paediatrics, Beatrix Children's Hospital, Groningen, The Netherlands.
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Waisman D, Faingersh A, Levy C, Colman-Klotzman I, Rotschild A, Lichtenstein O, Landesberg A. Transient decrease in PaCO(2) and asymmetric chest wall dynamics in early progressing pneumothorax. Intensive Care Med 2012. [PMID: 23179332 DOI: 10.1007/s00134-012-2749-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
PURPOSE Diagnosis of pneumothorax (PTX) in newborn infants has been reported as late. To explore diagnostic indices for early detection of progressing PTX, and offer explanations for delayed diagnoses. METHODS Progressing PTX was created in rabbits (2.3 ± 0.5 kg, n = 7) by injecting 1 ml/min of air into the pleural space. Hemodynamic parameters, tidal volume, EtCO(2), SpO(2), blood gas analyses and chest wall tidal displacements (TDi) on both sides of the chest were recorded. RESULTS (Mean ± SD): A decrease in SpO(2) below 90 % was detected only after 46.6 ± 11.3 min in six experiments. In contrary to the expected gradual increase of CO(2), there was a prolonged transient decrease of 14.2 ± 4.5 % in EtCO(2) (p < 0.01), and a similar decrease in PaCO(2) (p < 0.025). EtCO(2) returned back to baseline only after 55.2 ± 24.7 min, and continued to rise thereafter. The decrease in CO(2) was a mirror image of the 14.6 ± 5.3 % increase in tidal volume. The analysis of endotracheal flow and pressure dynamics revealed a paradoxical transient increase in the apparent compliance. Significant decrease in mean arterial blood pressure was observed after 46.2 ± 40.1 min. TDi provided the most sensitive and earliest sign of PTX, decreasing on the PTX side after 16.1 ± 7.2 min. The TDi progressively decreased faster and lower on the PTX side, thus enabling detection of asymmetric ventilation. CONCLUSIONS The counterintuitive transient prolonged decrease in CO(2) without changes in SpO(2) may explain the delay in diagnosis of PTX encountered in the clinical environment. An earlier indication of asymmetrically decreased ventilation on the affected side was achieved by monitoring the TDi.
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Affiliation(s)
- Dan Waisman
- Department of Neonatology, Faculty of Medicine, Carmel Medical Center, 7 Michal St, 34632, Haifa, Israel.
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Davidson J, Garcia KMB, Yi LC, Lucia Goulart A, dos Santos AMN. Prevalence and factors associated with thoracic alterations in infants born prematurely. Rev Assoc Med Bras (1992) 2012. [DOI: 10.1590/s0104-42302012000600012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Davidson J, Garcia KMB, Yi LC, Lucia Goulart A, dos Santos AMN. Prevalence and factors associated with thoracic alterations in infants born prematurely. Rev Assoc Med Bras (1992) 2012. [DOI: 10.1016/s0104-4230(12)70271-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Hepponstall JM, Tingay DG, Bhatia R, Loughnan PM, Copnell B. Effect of closed endotracheal tube suction method, catheter size, and post-suction recruitment during high-frequency jet ventilation in an animal model. Pediatr Pulmonol 2012; 47:749-56. [PMID: 22290736 DOI: 10.1002/ppul.21607] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2011] [Accepted: 11/03/2011] [Indexed: 11/10/2022]
Abstract
RATIONALE High-frequency jet ventilation (HFJV) is often used to treat infants with pathologies associated with gas trapping and abnormal lung mechanics, who are sensitive to the adverse effects of suction. OBJECTIVE This study aimed to investigate the effect of closed suction (CS), catheter size, and the use of active post-suction sighs on tracheal pressure (P(trach)), and global and regional end-expiratory lung volume (EELV) during HFJV. METHODS Six anaesthetized and muscle-relaxed adult rabbits were stabilized on HFJV. CS was performed using all permutations of three CS methods (Continual negative pressure, negative pressure applied during Withdrawal, and HFJV in Standby) and 6 French gauge (6 FG) and 8 French gauge (8 FG) catheter, randomly assigned. The sequence was repeated using post-suction sighs. P(trach), absolute (respiratory inductive plethysmography) and regional (electrical impedance tomography; expressed as percentage of vital capacity for the defined region of interest, %Z(VCroi) ) EELV were measured before, during and 60 sec post-suction. RESULTS CS methods exerted no difference on ΔP(trach), ΔEELV(RIP), or Δ%Z(VCroi) . 8FG catheter resulted in a mean (95%CI) 20.0 (17.9,22.2) cm H(2)O greater loss of P(trach) during suction compared to 6FG (Bonferroni post-test). Mean (± SD) ΔEELV(RIP) was -6(±3) and -2(±1) ml/kg with the 8 and 6 FG catheters (P < 0.0001; Bonferroni post-test). ΔEELV was 31.7 (21.1,42.4) %Z(VCroi) and 24.8 (10.9,38.7) %Z(VCroi) greater in the ventral and dorsal hemithoraces using the 8 FG. Only after 8 FG CS was post-suction recruitment required to restore EELV. CONCLUSIONS In this animal model receiving HFJV, ΔP(trach), ΔEELV, and need for post-suction recruitment during CS were most influenced by catheter size. Volume changes within the lung were uniform.
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Affiliation(s)
- J Michele Hepponstall
- Neonatal Research, Murdoch Children's Research Institute, Melbourne, Victoria 3052, Australia.
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Singh R, Courtney SE, Weisner MD, Habib RH. Respiratory mechanics during high-frequency oscillatory ventilation: a physical model and preterm infant study. J Appl Physiol (1985) 2012; 112:1105-13. [DOI: 10.1152/japplphysiol.01120.2011] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Accurate mechanics measurements during high-frequency oscillatory ventilation (HFOV) facilitate optimizing ventilator support settings. Yet, these are influenced substantially by endotracheal tube (ETT) contributions, which may dominate when leaks around uncuffed ETT are present. We hypothesized that 1) the effective removal of ETT leaks may be confirmed via direct comparison of measured vs. model-predicted mean intratracheal pressure [mPtr (meas) vs. mPtr (pred)], and 2) reproducible respiratory system resistance (Rrs) and compliance (Crs) may be derived from no-leak oscillatory Ptr and proximal flow. With the use of ETT test-lung models, proximal airway opening (Pao) and distal (Ptr) pressures and flows were measured during slow-cuff inflations until leaks are removed. These were repeated for combinations of HFOV settings [frequency, mean airway pressure (Paw), oscillation amplitudes (ΔP), and inspiratory time (%tI)] and varying test-lung Crs. Results showed that leaks around the ETT will 1) systematically reduce the effective distending pressures and lung-delivered oscillatory volumes, and 2) derived mechanical properties are increasingly nonphysiologic as leaks worsen. Mean pressures were systematically reduced along the ventilator circuit and ETT (Paw > Pao > Ptr), even for no-leak conditions. ETT size-specific regression models were then derived for predicting mPtr based on mean Pao (mPao), ΔP, %tI, and frequency. Next, in 10 of 11 studied preterm infants (0.77 ± 0.24 kg), no-to-minimal leak was confirmed based on excellent agreement between mPtr (meas) and mPtr (pred), and consequently, their oscillatory respiratory mechanics were evaluated. Infant resistance at the proximal ETT (RETT; resistance airway opening = RETT + Rrs; P < 0.001) and ETT inertance ( P = 0.014) increased significantly with increasing ΔP (50%, 100%, and 150% baseline), whereas Rrs showed a modest, nonsignificant increase ( P = 0.14), and Crs was essentially unchanged ( P = 0.39). We conclude that verifying no-leak conditions is feasible by comparison of model-derived vs. distending mPtr (meas). This facilitated the reliable and accurate assessment of physiologic respiratory mechanical properties that can objectively guide ventilatory management of HFOV-treated preterm infants.
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Affiliation(s)
- Rachana Singh
- Division of Newborn Medicine, Baystate Medical Center, Springfield, Massachusetts
| | - Sherry E. Courtney
- Division of Neonatology, Stony Brook University Medical Center, Stonybrook, New York
| | | | - Robert H. Habib
- Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
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Early detection of deteriorating ventilation by monitoring bilateral chest wall dynamics in the rabbit. Intensive Care Med 2011; 38:120-7. [PMID: 22105962 DOI: 10.1007/s00134-011-2398-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2011] [Accepted: 08/29/2011] [Indexed: 10/15/2022]
Abstract
PURPOSE Mechanical complications during assisted ventilation can evolve due to worsening lung disease or problems in airway management. These complications affect lung compliance or airway resistance, which in turn affect the chest wall dynamics. The objective of this study was to explore the utility of continuous monitoring of the symmetry and dynamics of chest wall motion in the early detection of complications during mechanical ventilation. METHODS The local tidal displacement (TDi) values of each side of the chest and epigastrium were measured by three miniature motion sensors in 18 rabbits. The TDi responses to changes in peak inspiratory pressure (n = 7), induction of one-lung intubation (n = 7), and slowly progressing pneumothorax (PTX) (n = 6) were monitored in parallel with conventional respiratory (SpO(2), EtCO(2), pressure and flow) and hemodynamic (HR and BP) indices. PTX was induced by injecting air into the pleural space at a rate of 1 mL/min. RESULTS A strong correlation (R(2) = 0.99) with a slope close to unity (0.94) was observed between percent change in tidal volume and in TDi. One-lung ventilation was identified by conspicuous asymmetry development between left and right TDis. These indices provided significantly early detection of uneven ventilation during slowly developing PTX (within 12.9 ± 6.6 min of onset, p = 0.02) almost 1 h before the SpO(2) dropped (77.3 ± 27.4 min, p = 0.02). Decreases in TDi of the affected side paralleled the progression of PTX. CONCLUSIONS Monitoring the local TDi is a sensitive method for detecting changes in tidal volume and enables early detection of developing asymmetric ventilation.
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Sarria EE, Mattiello R, Rao L, Tiller CJ, Poindexter B, Applegate KE, Granroth-Cook J, Denski C, Nguyen J, Yu Z, Hoffman E, Tepper RS. Quantitative assessment of chronic lung disease of infancy using computed tomography. Eur Respir J 2011; 39:992-9. [PMID: 22005925 DOI: 10.1183/09031936.00064811] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The aims of this study were to determine whether infants and toddlers with chronic lung disease of infancy (CLDI) have smaller airways and lower lung density compared with full-term healthy controls. Multi-slice computed tomography (CT) chest scans were obtained at elevated lung volumes during a brief respiratory pause in sedated infants and toddlers; 38 CLDI were compared with 39 full-term controls. For CLDI subjects, gestational age at birth ranged from 25 to 29 weeks. Airway size was measured for the trachea and the next three to four generations into the right lower lobe; lung volumes and tissue density were also measured. The relationship between airway size and airway generation differed between the CLDI and full-term groups; the sizes of the first and second airway generations were larger in the shorter CLDI than in the shorter full-term subjects. The increased size in the airways in the CLDI subjects was associated with increasing mechanical ventilation time in the neonatal period. CLDI subjects had a greater heterogeneity of lung density compared with full-term subjects. Our results indicate that quantitative analysis of multi-slice CT scans at elevated volumes provides important insights into the pulmonary pathology of infants and toddlers with CLDI.
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Affiliation(s)
- E E Sarria
- Dept of Pediatrics, James Whitcomb Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, IN 46202-5225, USA
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Davidson J, dos Santos AMN, Garcia KMB, Yi LC, João PC, Miyoshi MH, Goulart AL. Photogrammetry: an accurate and reliable tool to detect thoracic musculoskeletal abnormalities in preterm infants. Physiotherapy 2011; 98:243-9. [PMID: 22898582 DOI: 10.1016/j.physio.2011.05.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2010] [Accepted: 05/30/2011] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To analyse the accuracy and reproducibility of photogrammetry in detecting thoracic abnormalities in infants born prematurely. DESIGN Cross-sectional study. SETTING The Premature Clinic at the Federal University of São Paolo. PARTICIPANTS Fifty-eight infants born prematurely in their first year of life. OUTCOME MEASURES Measurement of the manubrium/acromion/trapezius angle (degrees) and the deepest thoracic retraction (cm). Digitised photographs were analysed by two blinded physiotherapists using a computer program (SAPO; http://SAPO.incubadora.fapesp.br) to detect shoulder elevation and thoracic retraction. Physical examinations performed independently by two physiotherapists were used to assess the accuracy of the new tool. RESULTS Thoracic alterations were detected in 39 (67%) and in 40 (69%) infants by Physiotherapists 1 and 2, respectively (kappa coefficient=0.80). Using a receiver operating characteristic curve, measurement of the manubrium/acromion/trapezius angle and the deepest thoracic retraction indicated accuracy of 0.79 and 0.91, respectively. For measurement of the manubrium/acromion/trapezius angle, the Bland and Altman limits of agreement were -6.22 to 7.22° [mean difference (d)=0.5] for repeated measures by one physiotherapist, and -5.29 to 5.79° (d=0.75) between two physiotherapists. For thoracic retraction, the intra-rater limits of agreement were -0.14 to 0.18cm (d=0.02) and the inter-rater limits of agreement were -0.20 to -0.17cm (d=0.02). CONCLUSION SAPO provided an accurate and reliable tool for the detection of thoracic abnormalities in preterm infants.
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Affiliation(s)
- Josy Davidson
- Department of Pediatrics-Neonatal Division of Medicine, Federal University of São Paulo, Rua Dr. Diogo de Faria 764, CEP 04037-002 São Paulo, SP, Brazil
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Lesnick BL, Davis SD. Infant pulmonary function testing: overview of technology and practical considerations--new current procedural terminology codes effective 2010. Chest 2011; 139:1197-1202. [PMID: 21540218 DOI: 10.1378/chest.10-1423] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Infant pulmonary function testing has evolved from a research technique into a diagnostic tool. As such, new current procedural terminology (CPT) codes have been created and are available for use as of January 1, 2010. The technology now available has a range of applications. Through a series of vignettes, this article illustrates the methodology of the tests, some of their applications, and how to code and bill for the procedures.
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Affiliation(s)
- Burton L Lesnick
- From Georgia Pediatric Pulmonary Associates, Atlanta, GA; Morehouse School of Medicine, Chapel Hill, NC.
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Lum S, Bush A, Stocks J. Clinical Pulmonary Function Testing for Children with Bronchopulmonary Dysplasia. PEDIATRIC ALLERGY IMMUNOLOGY AND PULMONOLOGY 2011; 24:77-88. [DOI: 10.1089/ped.2010.0059] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Sooky Lum
- Portex Respiratory Unit, UCL, Institute of Child Health, London, United Kingdom
| | - Andrew Bush
- Department of Paediatrics, Royal Brompton Hospital, London, United Kingdom
| | - Janet Stocks
- Portex Respiratory Unit, UCL, Institute of Child Health, London, United Kingdom
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Waisman D, Levy C, Faingersh A, Klotzman FIC, Konyukhov E, Kessel I, Rotschild A, Landesberg A. A new method for continuous monitoring of chest wall movement to characterize hypoxemic episodes during HFOV. Intensive Care Med 2011; 37:1174-81. [PMID: 21528388 DOI: 10.1007/s00134-011-2228-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2010] [Accepted: 02/26/2011] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Monitoring ventilated infants is difficult during high-frequency oscillatory ventilation (HFOV). This study tested the possible causes of hypoxemic episodes using a new method for monitoring chest wall movement during HFOV in newborn infants. METHODS Three miniature motion sensors were attached to both sides of the chest and to the epigastrium to measure the local tidal displacement (TDi) at each site. A >20% change in TDi was defined as deviation from baseline. RESULTS Eight premature infants (postmenstrual age 30.6 ± 2.6 weeks) were monitored during 10 sessions (32.6 h) that included 21 hypoxemic events. Three types of such events were recognized: decrease in TDi that preceded hypoxemia (n = 11), simultaneous decrease in TDi and SpO2 (n = 6), and decrease in SpO(2) without changes in TDi (n = 4). In the first group, decreases in TDi were detected 22.4 ± 18.7 min before hypoxemia, and were due to airway obstruction by secretions or decline in lung compliance. The second group resulted from apnea or severe abdominal contractions. In the third group, hypoxia appeared following a decrease in FiO2. CONCLUSIONS Monitoring TDi may enable early recognition of deteriorating ventilation during HFOV that eventually leads to hypoxemia. In about half of cases, hypoxemia is not due to slowly deteriorating ventilation.
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Affiliation(s)
- Dan Waisman
- Department of Neonatology, Carmel Medical Center and Faculty of Medicine, 7 Michal St, 34362, Haifa, Israel.
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Kneyber MCJ, van Heerde M, Twisk JWR, Plötz FB, Markhors DG. Heliox reduces respiratory system resistance in respiratory syncytial virus induced respiratory failure. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2009; 13:R71. [PMID: 19450268 PMCID: PMC2717432 DOI: 10.1186/cc7880] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/12/2008] [Revised: 04/20/2009] [Accepted: 05/15/2009] [Indexed: 11/10/2022]
Abstract
INTRODUCTION Respiratory syncytial virus (RSV) lower respiratory tract disease is characterised by narrowing of the airways resulting in increased airway resistance, air-trapping and respiratory acidosis. These problems might be overcome using helium-oxygen gas mixture. However, the effect of mechanical ventilation with heliox in these patients is unclear. The objective of this prospective cross-over study was to determine the effects of mechanical ventilation with heliox 60/40 versus conventional gas on respiratory system resistance, air-trapping and CO2 removal. METHODS Mechanically ventilated, sedated and paralyzed infants with proven RSV were enrolled within 24 hours after paediatric intensive care unit (PICU)admission. At T = 0, respiratory system mechanics including respiratory system compliance and resistance, and peak expiratory flow rate were measured with the AVEA ventilator. The measurements were repeated at each interval (after 30 minutes of ventilation with heliox, after 30 minutes of ventilation with nitrox and again after 30 minutes of ventilation with heliox). Indices of gas exchange (ventilation and oxygenation index) were calculated at each interval. Air-trapping (defined by relative change in end-expiratory lung volume) was determined by electrical impedance tomography (EIT) at each interval. RESULTS Thirteen infants were enrolled. In nine, EIT measurements were performed. Mechanical ventilation with heliox significantly decreased respiratory system resistance. This was not accompanied by an improved CO2 elimination, decreased peak expiratory flow rate or decreased end-expiratory lung volume. Importantly, oxygenation remained unaltered throughout the experimental protocol. CONCLUSIONS Respiratory system resistance is significantly decreased by mechanical ventilation with heliox (ISCRTN98152468).
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Affiliation(s)
- Martin C J Kneyber
- Department of Pediatric Intensive Care, VU university medical center, Amsterdam, The Netherlands.
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Frerichs C, Smyth A. Treatment strategies for cystic fibrosis: what's in the pipeline? Expert Opin Pharmacother 2009; 10:1191-202. [DOI: 10.1517/14656560902928896] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Lung volume, breathing pattern and ventilation inhomogeneity in preterm and term infants. PLoS One 2009; 4:e4635. [PMID: 19247491 PMCID: PMC2645689 DOI: 10.1371/journal.pone.0004635] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2008] [Accepted: 01/21/2009] [Indexed: 11/24/2022] Open
Abstract
Background Morphological changes in preterm infants with bronchopulmonary dysplasia (BPD) have functional consequences on lung volume, ventilation inhomogeneity and respiratory mechanics. Although some studies have shown lower lung volumes and increased ventilation inhomogeneity in BPD infants, conflicting results exist possibly due to differences in sedation and measurement techniques. Methodology/Principal Findings We studied 127 infants with BPD, 58 preterm infants without BPD and 239 healthy term-born infants, at a matched post-conceptional age of 44 weeks during quiet natural sleep according to ATS/ERS standards. Lung function parameters measured were functional residual capacity (FRC) and ventilation inhomogeneity by multiple breath washout as well as tidal breathing parameters. Preterm infants with BPD had only marginally lower FRC (21.4 mL/kg) than preterm infants without BPD (23.4 mL/kg) and term-born infants (22.6 mL/kg), though there was no trend with disease severity. They also showed higher respiratory rates and lower ratios of time to peak expiratory flow and expiratory time (tPTEF/tE) than healthy preterm and term controls. These changes were related to disease severity. No differences were found for ventilation inhomogeneity. Conclusions Our results suggest that preterm infants with BPD have a high capacity to maintain functional lung volume during natural sleep. The alterations in breathing pattern with disease severity may reflect presence of adaptive mechanisms to cope with the disease process.
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Marchese AD, Chipman D, de la Oliva P, Kacmarek RM. Adult ICU ventilators to provide neonatal ventilation: a lung simulator study. Intensive Care Med 2008; 35:631-8. [PMID: 18931831 DOI: 10.1007/s00134-008-1332-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2008] [Accepted: 10/06/2008] [Indexed: 11/29/2022]
Abstract
BACKGROUND Traditionally, specific ventilators have been manufactured to only provide neonatal mechanical ventilation. However, many of the current generation of ICU ventilators also include a neonatal mode. METHODS Using the IngMar ASL5000 lung simulator the Puritan Bennett 840, the Maquet Servo i, the Viasys AVEA, the GE Engström, the Drager Evita XL and Babylog 8000 Plus were evaluated during assisted ventilation in the pressure assist/control mode. Three lung mechanics were set: resistance 50 cmH(2)O/L/s, compliance 2 mL/cmH(2)O; resistance 100 cmH(2)O/L/s, compliance 1 mL/cmH(2)O; and resistance 150 cmH(2)O/L/s, compliance 0.5 mL/cmH(2)O. A maximum negative pressure drop of 4 and 7 cmH(2)O was achieved during simulated inspirations. Each ventilator was evaluated with PEEP 5 cmH(2)O, peak pressure 20 cmH(2)O and inspiratory time 0.3 s and with PEEP 10 cmH(2)O, peak pressure 30 cmH(2)O and inspiratory time 0.4 s. Each ventilator setting was then repeated with a leak of 0.3 L/min at a constant pressure of 5 cmH(2)O. RESULTS Overall each of the 5 ICU ventilators responded faster or greater than the Babylog with respect to: pressure to trigger (except the Servo i), time to trigger (except the Evita XL), time between trigger and return of pressure to baseline, time from start of breath to 90% of peak pressure (except the Avea) and pressure time product of breath activation. Expiratory tidal volume was also greater with all ICU ventilators except the Avea. Variation in mechanics, leak, PEEP and muscular effort had little effect on these differences. CONCLUSION All ICU ventilators tested were able to at least equal the performance of the Babylog 8000 Plus on all variables evaluated.
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Affiliation(s)
- Andrew D Marchese
- Respiratory Care Massachusetts General Hospital, Boston, MA 02114, USA
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Riedel T, Kyburz M, Latzin P, Thamrin C, Frey U. Regional and overall ventilation inhomogeneities in preterm and term-born infants. Intensive Care Med 2008; 35:144-51. [DOI: 10.1007/s00134-008-1299-x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2008] [Accepted: 09/03/2008] [Indexed: 10/21/2022]
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Kairamkonda VR, Richardson J, Subhedar N, Bridge PD, Shaw NJ. Lung function measurement in prematurely born preschool children with and without chronic lung disease. J Perinatol 2008; 28:199-204. [PMID: 18185519 DOI: 10.1038/sj.jp.7211911] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Prematurely born infants often have recurrent wheeze and long-term respiratory morbidity at follow-up. Assessment of airways obstruction in preschool children is feasible using the interrupter resistance (Rint) but has rarely been examined in preterm children with and without chronic lung disease (CLD). The objective of this study was to determine lung function measured by the interrupter technique, its feasibility in the ambulatory setting and respiratory health in prematurely born preschool children with and without CLD. STUDY DESIGN Preterm children of 2 to 4 years with severe CLD (>30% oxygen at 36 weeks and discharged home receiving supplemental oxygen) (n=43, median gestational age 27 weeks and median birth weight 995 g) and without CLD (n=33, median gestational age 29 weeks and median birth weight 1366 g) attempting lung function test for the first time were enrolled. Respiratory symptoms score was calculated using a questionnaire. A single set of 10 consecutive Rint measurements was obtained using a portable device (MicroRint). Median of at least five occlusions with consistent shape of mouth pressure-time curves was taken to be a Rint measurement. To assess feasibility the children were categorized as 'satisfactory', 'failure' and 'rejected' depending on the outcome of the test. Outcome variables were respiratory symptoms score and Rint. RESULT Satisfactory Rint measurement was obtained in 46 (61%) children, 9 (36%) 2-year olds, 17 (65%) 3-year olds and 20 (80%) 4-year olds. As compared with the preterm control children (n=18), CLD children (n=28) had significantly higher respiratory symptoms score (18.5 vs 6, P<0.01) and Rint expressed as absolute values (kPa l(-1)) and z-scores (1.33 vs 1.16 and 1.42 vs 1.0, P<0.01), respectively. CONCLUSION Rint measurement is feasible in prematurely born children of preschool age in the ambulatory setup. Preschool children with severe CLD may be identified from preterm children without CLD by increased Rint that may be used as a screening tool and as an outcome measure for interventions.
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Affiliation(s)
- V R Kairamkonda
- Department of Neonatal Intensive Care, Leicester Royal Infirmary, Leicester, UK.
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Effects of inertance on respiratory mechanics measurements in mechanically ventilated children. Pediatr Crit Care Med 2008; 9:80-5. [PMID: 18477918 DOI: 10.1097/01.pcc.0000298657.33263.50] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The use of the first-order linear single compartment model when studying respiratory mechanics classically neglects inertance (Irs). We hypothesized that Irs would affect compliance (Crs) and resistance (Rrs) estimates in mechanically ventilated young children. DESIGN Prospective study; single-center evaluation. SETTING University-affiliated tertiary pediatric intensive care unit. PATIENTS Forty-four patients with and without respiratory disease. INTERVENTIONS Patients were studied during volume-controlled constant inspiratory flow ventilation. MEASUREMENTS AND MAIN RESULTS Pressure (PaO) and flow (V') were analyzed according to two different models: a one-compartment first-order linear model according to PaO = (1/Crs) x V + Rrs x V' and a one-compartment second-order linear model according to PaO = (1/Crs) x V + Rrs x V' + Irs x V''. Irs was higher in children with vs. those without respiratory disease (median 0.00224 cm H2O/L/sec2, Q1-Q3 0.00180-0.00321 vs. median 0.00133 cm H2O/L/sec2, Q1-Q3 0.00072-0.00210; p < .001)). A positive correlation between Irs and the difference of Crs estimates between the first- and the second-order model was found in both groups (r = .84, p < .05 and r = .67, p < .05). Rrs estimates were similar in both groups. CONCLUSIONS This study showed that the linear single-compartment model may not adequately estimate the respiratory mechanical properties in mechanically ventilated children, particularly in the presence of respiratory disease. Including an Irs term significantly diminished Crs estimates. A one-compartment second-order linear model might be a useful clinical tool in more adequately measuring respiratory mechanics and optimizing ventilatory settings in children with respiratory disease.
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Gauthier R, Matecki S, Le Bourgeois M, Couderc L. [Evaluation of respiratory function in infants with cystic fibrosis. Synopsis of the "Respiratory Functional Explorations" working group of the French Society of Cystic Fibrosis (CRCM)]. REVUE DE PNEUMOLOGIE CLINIQUE 2007; 63:254-262. [PMID: 17978737 DOI: 10.1016/s0761-8417(07)92649-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Affiliation(s)
- R Gauthier
- Unité d'Explorations Fonctionnelles Respiratoires Pédiatriques et NéoNatales, CHU Nord, place Victor-Pauchet, 80054 Amiens.
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Dotta A, Palamides S, Braguglia A, Crescenzi F, Ronchetti MP, Calzolari F, Iacobelli BD, Bagolan P, Corchia C, Orzalesi M. Lung volumes and distribution of ventilation in survivors to congenital diaphragmatic hernia (CDH) during infancy. Pediatr Pulmonol 2007; 42:600-4. [PMID: 17526007 DOI: 10.1002/ppul.20609] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
UNLABELLED The assessment of lung volumes, particularly functional residual capacity (FRC), is crucial for understanding lung development during infancy in CDH patients. AIM To evaluate changes in lung function during infancy in subjects with CDH treated with a "gentle ventilation" technique and delayed surgery strategy in the neonatal period. METHODS 13 CDH infants were studied twice and compared with a population of 28 healthy infants (HI). Tidal-Volume (Vt), respiratory rate (RR) and time to peak expiratory flow/expiratory time ratio (tPTEF/Te) were measured with an ultrasonic flow meter; Compliance (Crs) and Resistance (Rrs) of the respiratory system were studied with the single occlusion technique; FRC and Lung Clearance Index (LCI), were assessed with the sulfur hexafluoride (SF6) wash-in/wash-out technique. The differences between the first (T1) and second (T2) measurement in the CDH group were assessed by the Student's t-test for paired values. For each set of measurement (T1 and T2) the values were compared with HI by Student's t-test. RESULTS Mean age at test was 7.5 +/- 5.2 months for HI, 4.5 +/- 2.5 at T1 and 11.9 +/- 4.5 months at T2 for CDH infants. At T1 there were no significant differences between CDH infants and HI in Vt, Crs, and FRC, while tPTEF/te ratio was lower and RR, Rrs, and LCI were higher in CDH patients than in HI. At T2 Vt, Crs, and FRC remained normal in CDH patients as well as RR that, at this time was not different between CDH and healthy infants; tPTEF/te remained below and Rrs and LCI remained above normal ranges, indicating a persistent impairment in lower airways patency. CONCLUSIONS Lung function in infants with severe CDH is characterized by a persistent impairment in airways patency and significant inhomogeneity of ventilation, suggesting a peripheral bronchial obstruction even if the other lung function tests are within normal ranges.
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Affiliation(s)
- Andrea Dotta
- Department of Medical and Surgical Neonatology, Bambino Gesù Children's Hospital-IRCCS, Rome, Italy.
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Vrijlandt EJLE, Boezen HM, Gerritsen J, Stremmelaar EF, Duiverman EJ. Respiratory health in prematurely born preschool children with and without bronchopulmonary dysplasia. J Pediatr 2007; 150:256-61. [PMID: 17307541 DOI: 10.1016/j.jpeds.2006.12.007] [Citation(s) in RCA: 122] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2006] [Revised: 10/04/2006] [Accepted: 12/06/2006] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To investigate the respiratory health of preterm infants with bronchopulmonary dysplasia (BPD) at preschool age and to determine whether lung function (measured by forced oscillation technique (FOT) and interruption technique (Rint) is affected by BPD in preterm infants compared with preterm infants without BPD. PARTICIPANTS 3 to 5 years of age born preterm with BPD (N = 40, mean gestational age 28 weeks, mean birth weight 1051 g), and without BPD (N = 36, mean gestational age 29 weeks, mean birth weight 1179 g). OUTCOME VARIABLES prevalence of symptoms determined by European Community Respiratory Health Survey and lung function measured by FOT and Rint. RESULTS A large percentage of infants in both preterm groups reported respiratory symptoms during the last 12 months. Lung function measurements showed higher resonant frequency (Hz) in BPD compared with non-BPD (mean 26.8 vs 22.7, P < .001) and lower mean reactance X(4-24) (hPa.s/l)(-3.0 vs -1.9, P = .005). No differences were found in respiratory resistance between the groups, although the mean values of both groups were increased compared with reference values. CONCLUSION Preterm birth affects respiratory health at 3 to 5 years of age. Children with BPD could be distinguished from children without BPD based on a higher resonant frequency and a lower mean reactance.
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Affiliation(s)
- E J L E Vrijlandt
- Department of Pediatric Pulmonology, University Medical Center Groningen, University of Groningen, The Netherlands.
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Stocks J, Coates A, Bush A. Lung function in infants and young children with chronic lung disease of infancy: the next steps? Pediatr Pulmonol 2007; 42:3-9. [PMID: 17123320 DOI: 10.1002/ppul.20520] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Over the past year, a series of papers have reviewed the literature concerning assessment and interpretation of lung function in infants and young children with chronic lung disease of infancy. This manuscript, which represents the final paper in that series, summarizes the findings to date and highlights key areas for future research. Despite the huge literature in this field, interpretation of results and their use in guiding clinical management are still limited by difficulties in 'normalizing data' according to body size and maturation and selection of appropriate control groups. Furthermore, sensitive tests that more closely reflect the underlying pathophysiology of 'new' bronchopulmonary dysplasia, together with simple and reliable methods of assessing lung maturity at birth and true oxygen requirements at specified time points are urgently required. Research in this field is also challenged by the need to separate the independent effects of genetic predisposition, gene-environment interactions, preterm delivery, neonatal respiratory disorders and various treatment strategies on the growing lung. The extent to which disruption of lung growth following premature exposure to the extra-uterine environment leads to an earlier or more aggravated decline in respiratory function in later adult life remains to be elucidated. Whatever its origin, given the increasing survival of smaller and more immature infants, the long term sequelae of neonatal lung disease, are likely to continue to change, requiring ongoing, carefully designed longitudinal studies. Future research strategies need to encompass a multicenter, multi-disciplinary, collaborative approach with closer links between clinicians and basic scientists, to ensure that the most relevant research questions are addressed using appropriate methodology and that findings are implemented into clinical practice in a more timely fashion.
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Affiliation(s)
- Janet Stocks
- Portex Anaesthesia, Intensive Therapy and Respiratory Medicine Unit, UCL, Institute of Child Health and Great Ormond Street Hospital for Children NHS Trust, London, United Kingdom.
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