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Delecaris AO, Averill SH, Krasinkiewicz J, Saunders JL, Ren CL. Pediatric pulmonology year in review 2020: Physiology. Pediatr Pulmonol 2021; 56:2444-2448. [PMID: 34043883 DOI: 10.1002/ppul.25504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 05/11/2021] [Accepted: 05/13/2021] [Indexed: 11/06/2022]
Abstract
Pulmonary physiology is a core element of pediatric pulmonology care and research. This article reviews some of the notable publications in physiology that were published in Pediatric Pulmonology in 2020.
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Affiliation(s)
- Angela O Delecaris
- Division of Pediatric Pulmonology, Allergy and Sleep Medicine, Riley Hospital for Children, Indianapolis, Indiana, USA.,Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Samantha H Averill
- Division of Pediatric Pulmonology, Allergy and Sleep Medicine, Riley Hospital for Children, Indianapolis, Indiana, USA.,Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Jonathan Krasinkiewicz
- Division of Pediatric Pulmonology, Allergy and Sleep Medicine, Riley Hospital for Children, Indianapolis, Indiana, USA.,Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Jessica L Saunders
- Division of Pediatric Pulmonology, Allergy and Sleep Medicine, Riley Hospital for Children, Indianapolis, Indiana, USA.,Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Clement L Ren
- Division of Pediatric Pulmonology, Allergy and Sleep Medicine, Riley Hospital for Children, Indianapolis, Indiana, USA.,Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana, USA
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Handley BM, Jeagal E, Schoeffel RE, Badal T, Chapman DG, Farrow CE, King GG, Robinson PD, Milne S, Thamrin C. Controlled versus free breathing for multiple breath nitrogen washout in healthy adults. ERJ Open Res 2021; 7:00435-2020. [PMID: 33532457 PMCID: PMC7836463 DOI: 10.1183/23120541.00435-2020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 10/16/2020] [Indexed: 11/18/2022] Open
Abstract
Multiple breath nitrogen washout (MBNW) quantifies ventilation heterogeneity. Two distinct protocols are currently used for MBNW testing: “controlled breathing”, with targeted tidal volume (VT) and respiratory rate (RR); and “free breathing”, with no constraints on breathing pattern. Indices derived from the two protocols (functional residual capacity (FRC), lung clearance index (LCI), Scond, Sacin) have not been directly compared in adults. We aimed to determine whether MBNW indices are comparable between protocols, to identify factors underlying any between-protocol differences and to determine the between-session variabilities of each protocol. We performed MBNW testing by both protocols in 27 healthy adult volunteers, applying the currently proposed correction for VT to Scond and Sacin derived from free breathing. To establish between-session variability, we repeated testing in 15 volunteers within 3 months. While FRC was comparable between controlled versus free breathing (3.17 (0.98) versus 3.18 (0.94) L, p=0.88), indices of ventilation heterogeneity derived from the two protocols were not, with poor correlation for Scond (r=0.18, p=0.36) and significant bias for Sacin (0.057 (0.021) L−1versus 0.085 (0.038) L−1, p=0.0004). Between-protocol differences in Sacin were related to differences in the breathing pattern, i.e. VT (p=0.004) and RR (p=0.01), rather than FRC. FRC and LCI showed good between-session repeatability, but Scond and Sacin from free breathing showed poor repeatability with wide limits of agreement. These findings have implications for the ongoing clinical implementation of MBNW, as they demonstrate that Scond and Sacin from free breathing, despite VT correction, are not equivalent to the controlled breathing protocol. The poor between-session repeatability of Scond during free breathing may limit its clinical utility. Phase 3 slopes indices derived from “free breathing” and “controlled breathing” MBNW protocols are not comparable, and differences are related to breathing patterns. These findings have implications for the ongoing clinical implementation of MBNW.https://bit.ly/35oQYnW
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Affiliation(s)
- Blake M Handley
- Dept of Respiratory Medicine, Royal North Shore Hospital, St Leonards, NSW, Australia.,Woolcock Institute of Medical Research, University of Sydney, Glebe, NSW, Australia
| | - Edward Jeagal
- Woolcock Institute of Medical Research, University of Sydney, Glebe, NSW, Australia
| | - Robin E Schoeffel
- Dept of Respiratory Medicine, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Tanya Badal
- Woolcock Institute of Medical Research, University of Sydney, Glebe, NSW, Australia
| | - David G Chapman
- Woolcock Institute of Medical Research, University of Sydney, Glebe, NSW, Australia.,Translational Airways Group, School of Life Sciences, Faculty of Science, University of Technology Sydney, Ultimo, NSW, Australia
| | - Catherine E Farrow
- Woolcock Institute of Medical Research, University of Sydney, Glebe, NSW, Australia.,Dept of Respiratory and Sleep Medicine, Westmead Hospital, Westmead, NSW, Australia
| | - Gregory G King
- Dept of Respiratory Medicine, Royal North Shore Hospital, St Leonards, NSW, Australia.,Woolcock Institute of Medical Research, University of Sydney, Glebe, NSW, Australia.,Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia
| | - Paul D Robinson
- Dept of Respiratory Medicine, The Children's Hospital at Westmead, Westmead, NSW, Australia
| | - Stephen Milne
- Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia.,Centre for Heart Lung Innovation, St Paul's Hospital and Division of Respiratory Medicine, University of British Columbia, Vancouver, BC, Canada.,These authors contributed equally
| | - Cindy Thamrin
- Woolcock Institute of Medical Research, University of Sydney, Glebe, NSW, Australia.,Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia.,These authors contributed equally
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