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Kovatis K, Mackley A, Traczykiewicz S, Subedi K, Rahman T, Shaffer TH. Oxygen saturation and work of breathing indices in preterm infants with bronchopulmonary dysplasia compared to healthy preterm infants at discharge. J Neonatal Perinatal Med 2024:NPM230222. [PMID: 38968059 DOI: 10.3233/npm-230222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/07/2024]
Abstract
BACKGROUND Thoracoabdominal asynchrony (TAA) is commonly seen in preterm infants. Respiratory inductive plethysmography (RIP) is a noninvasive way to objectively assess work of breathing (WOB) indices. The impact of bronchopulmonary dysplasia (BPD) on TAA at discharge has not been established. The aim of this study is to compare WOB indices in premature infants with a diagnosis of BPD to premature infants without a diagnosis of BPD at discharge. METHODS A prospective, observational study of premature infants (<32 weeks gestation) at discharge during quiet breathing in the supine position. RIP noninvasively measured WOB indices. A high-resolution pulse oximeter collected oxygen saturation and heart rate data. RESULTS This study included thirty-one infants with BPD and thirty-four infants without BPD. Infants diagnosed with BPD had increased phase angle [BPD Φ = 73 . 90 (8.2) vs NoBPD Φ = 52.6 (8.2), p = 0.039]. Infants diagnosed with BPD had decreased saturations [BPD SpO2 = 96% (0.4) vs NoBPD Sp02 98% (0.3), p=<0.001], increased time with saturations less than 85% [BPD % =2.74 (0.7) vs NoBPD % =0.91 (0.4), p = .018], and increased time with saturations less than 80% [BPD % =1.57 (0.5) vs NoBPD % =0.52 (0.3), p = 0.045]. There was no difference in heart rate or breaths per minute for infants with BPD versus controls. CONCLUSION Premature infants with BPD demonstrated increased TAA and had lower saturations compared to infants without BPD at discharge despite being chronologically older and being discharged at an older corrected gestational age. The impact of BPD on breathing patterns persists at discharge and suggests these patients may have residual lung and/or respiratory muscle dysfunction.
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Affiliation(s)
- K Kovatis
- Department of Neonatology, ChristianaCare. Newark DE, USA
| | - A Mackley
- Department of Neonatology, ChristianaCare. Newark DE, USA
| | | | - K Subedi
- Institute for Research on Equity and Community Health (iREACH), ChristianaCare, Newark, DE, USA
| | - T Rahman
- Nemours Biomedical Research, Nemours Children's Health, Wilmington, DE, USA
| | - T H Shaffer
- Department of Pediatrics, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
- Department of Physiology, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, USA
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Cerina L, Papini GB, Fonseca P, Overeem S, van Dijk JP, van Meulen F, Vullings R. Quantitative validation of the suprasternal pressure signal to assess respiratory effort during sleep. Physiol Meas 2024; 45:055020. [PMID: 38749433 DOI: 10.1088/1361-6579/ad4c35] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 05/15/2024] [Indexed: 05/30/2024]
Abstract
Objective.Intra-esophageal pressure (Pes) measurement is the recommended gold standard to quantify respiratory effort during sleep, but used to limited extent in clinical practice due to multiple practical drawbacks. Respiratory inductance plethysmography belts (RIP) in conjunction with oronasal airflow are the accepted substitute in polysomnographic systems (PSG) thanks to a better usability, although they are partial views on tidal volume and flow rather than true respiratory effort and are often used without calibration. In their place, the pressure variations measured non-invasively at the suprasternal notch (SSP) may provide a better measure of effort. However, this type of sensor has been validated only for respiratory events in the context of obstructive sleep apnea syndrome (OSA). We aim to provide an extensive verification of the suprasternal pressure signal against RIP belts and Pes, covering both normal breathing and respiratory events.Approach.We simultaneously acquired suprasternal (207) and esophageal pressure (20) signals along with RIP belts during a clinical PSG of 207 participants. In each signal, we detected breaths with a custom algorithm, and evaluated the SSP in terms of detection quality, breathing rate estimation, and similarity of breathing patterns against RIP and Pes. Additionally, we examined how the SSP signal may diverge from RIP and Pes in presence of respiratory events scored by a sleep technician.Main results.The SSP signal proved to be a reliable substitute for both esophageal pressure (Pes) and respiratory inductance plethysmography (RIP) in terms of breath detection, with sensitivity and positive predictive value exceeding 75%, and low error in breathing rate estimation. The SSP was also consistent with Pes (correlation of 0.72, similarity 80.8%) in patterns of increasing pressure amplitude that are common in OSA.Significance.This work provides a quantitative analysis of suprasternal pressure sensors for respiratory effort measurements.
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Affiliation(s)
- Luca Cerina
- Electrical Engineering, Technische Universiteit Eindhoven, Eindhoven, Noord Brabant, The Netherlands
| | - Gabriele B Papini
- Electrical Engineering, Technische Universiteit Eindhoven, Eindhoven, Noord Brabant, The Netherlands
- Philips Research, Eindhoven, Noord Brabant, The Netherlands
| | - Pedro Fonseca
- Electrical Engineering, Technische Universiteit Eindhoven, Eindhoven, Noord Brabant, The Netherlands
- Philips Research, Eindhoven, Noord Brabant, The Netherlands
| | - Sebastiaan Overeem
- Electrical Engineering, Technische Universiteit Eindhoven, Eindhoven, Noord Brabant, The Netherlands
- Center for Sleep Medicine, Kempenhaeghe Foundation, Heeze, Noord Brabant, The Netherlands
| | - Johannes P van Dijk
- Electrical Engineering, Technische Universiteit Eindhoven, Eindhoven, Noord Brabant, The Netherlands
- Center for Sleep Medicine, Kempenhaeghe Foundation, Heeze, Noord Brabant, The Netherlands
| | - Fokke van Meulen
- Electrical Engineering, Technische Universiteit Eindhoven, Eindhoven, Noord Brabant, The Netherlands
- Center for Sleep Medicine, Kempenhaeghe Foundation, Heeze, Noord Brabant, The Netherlands
| | - Rik Vullings
- Electrical Engineering, Technische Universiteit Eindhoven, Eindhoven, Noord Brabant, The Netherlands
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Sayas J, Lalmolda C, Corral M, Flórez P, Hernández-Voth A, Janssens JP, Rabec C, Langevin B, Lofaso F, Carlucci A, Llontop C, Winck JC, Bermejo JG, Lujan M. Measurement of thoraco-abdominal synchrony using respiratory inductance plethysmography: technical aspects and a proposal to overcome its limitations. Expert Rev Respir Med 2024; 18:227-236. [PMID: 38829281 DOI: 10.1080/17476348.2024.2363058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 04/12/2024] [Indexed: 06/05/2024]
Abstract
BACKGROUND Thoraco-abdominal asynchrony (TAA) is usually assessed by respiratory inductance plethysmography. The main parameter used for its assessment is the calculation of the phase angle based on Lissajous plots. However, there are some mathematical limitations to its use. RESEARCH DESIGN AND METHODS Sequences of five breaths were selected from a) normal subjects, b) COPD patients, both at rest and during exercise, and c) patients with obstructive apnea syndrome. Automated analysis was performed calculating phase angle, loop rotation (clockwise or counterclockwise), global phase delay and loop area. TAA severity was estimated quantitatively and in subgroups. RESULTS 2290 cycles were analyzed (55% clockwise rotation). Phase angle ranged from -86.90 to + 88.4 degrees, while global phase delay ranged from -179.75 to + 178.54. Despite a good correlation with global phase delay (p < 0.01, ANOVA test), phase angle and loop area were not able to correctly classify breaths with severe deviation and paradoxical movements (p=ns, Bonferroni post hoc test). CONCLUSIONS Global phase delay covers the whole spectrum of TAA situations in a single value. It may be a relevant parameter for diagnosis and follow-up of clinical conditions leading to TAA. CLINICAL TRIAL REGISTRATION The trial from which the traces were obtained was registered at ClinicalTrials.gov ;(identifier: NCT04597606).
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Affiliation(s)
- Javier Sayas
- Pulmonology Service, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Madrid, Spain
| | - Cristina Lalmolda
- Servei de Pneumologia, Parc Taulí Hospital Universitari. Institut d'Investigació i Innovació Parc Taulí (I3PT-CERCA), Universitat Autònoma de Barcelona, Sabadell, Spain
| | - Marta Corral
- Pulmonology Service, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Madrid, Spain
| | - Pablo Flórez
- Servei de Pneumologia, Parc Taulí Hospital Universitari. Institut d'Investigació i Innovació Parc Taulí (I3PT-CERCA), Universitat Autònoma de Barcelona, Sabadell, Spain
| | - Ana Hernández-Voth
- Pulmonology Service, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Madrid, Spain
| | - Jean Paul Janssens
- Division of Pneumology, Geneva University Hospitals, Geneva, Switzerland
- Medicine, University of Geneva, Geneva, Switzerland
| | - Claudio Rabec
- Department of Pulmonary Medicine and Intensive Care Unit. Constitutive Reference Center for Rare Pulmonary Diseases, University Hospital of Dijon Bourgogne, Dijon, France
| | - Bruno Langevin
- Réanimation, Pôle Soins Aigus, Centre Hospitalier Alès, Alès, France
| | - Frédéric Lofaso
- INSERM-UMR 1179, Versailles Saint-Quentin University, Paris Saclay University, France
- Department of Physiology, AP-HP, Hôpital Raymond Poincaré, Garches, France
| | - Annalisa Carlucci
- Dipartimento di Medicina e Chirurgia, Università Insubria Varese-Como. Pneumologia Riabilitativa. Istituti Clinici Scientifici Maugeri-Pavia, Pavia, Italy
| | - Claudia Llontop
- Unité ambulatoire d'appareillage respiratoire de domicile. Département R3S (Respiration Réanimation, Réhabilitation, Sommeil), Groupe hospitalier Pitié-Salpêtrière, Paris, France
| | - Joao Carlos Winck
- UniC Cardiovascular R&D Centre, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | - Jesús González Bermejo
- Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique; AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, site Pitié-Salpêtrière, Département R3S (Respiration, Réanimation, Réadaptation respiratoire, Sommeil), Service de médecine de readaptation respiratoire, Paris, France
| | - Manel Lujan
- Servei de Pneumologia, Parc Taulí Hospital Universitari. Institut d'Investigació i Innovació Parc Taulí (I3PT-CERCA), Universitat Autònoma de Barcelona, Sabadell, Spain
- CIBERES, Madrid, Spain
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Molinaro N, Schena E, Silvestri S, Massaroni C. Breathing Chest Wall Kinematics Assessment through a Single Digital Camera: A Feasibility Study. SENSORS (BASEL, SWITZERLAND) 2023; 23:6960. [PMID: 37571742 PMCID: PMC10422340 DOI: 10.3390/s23156960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 08/02/2023] [Accepted: 08/03/2023] [Indexed: 08/13/2023]
Abstract
The identification of respiratory patterns based on the movement of the chest wall can assist in monitoring an individual's health status, particularly those with neuromuscular disorders, such as hemiplegia and Duchenne muscular dystrophy. Thoraco-abdominal asynchrony (TAA) refers to the lack of coordination between the rib cage and abdominal movements, characterized by a time delay in their expansion. Motion capture systems, like optoelectronic plethysmography (OEP), are commonly employed to assess these asynchronous movements. However, alternative technologies able to capture chest wall movements without physical contact, such as RGB digital cameras and time-of-flight digital cameras, can also be utilized due to their accessibility, affordability, and non-invasive nature. This study explores the possibility of using a single RGB digital camera to record the kinematics of the thoracic and abdominal regions by placing four non-reflective markers on the torso. In order to choose the positions of these markers, we previously investigated the movements of 89 chest wall landmarks using OEP. Laboratory tests and volunteer experiments were conducted to assess the viability of the proposed system in capturing the kinematics of the chest wall and estimating various time-related respiratory parameters (i.e., fR, Ti, Te, and Ttot) as well as TAA indexes. The results demonstrate a high level of agreement between the detected chest wall kinematics and the reference data. Furthermore, the system shows promising potential in estimating time-related respiratory parameters and identifying phase shifts indicative of TAA, thus suggesting its feasibility in detecting abnormal chest wall movements without physical contact with a single RGB camera.
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Affiliation(s)
| | | | - Sergio Silvestri
- Unit of Measurements and Biomedical Instrumentation, Università Campus Bio-Medico di Roma, 00128 Rome, Italy; (N.M.); (E.S.); (C.M.)
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Zeng Y, Song X, Yang J, Wang W. Time-domain Features of Angular-velocity Signals for Camera-based Respiratory RoI detection: A Clinical Study in NICU. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2023; 2023:1-6. [PMID: 38083770 DOI: 10.1109/embc40787.2023.10340063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
Camera-based measurement of respiratory rate (RR) is emerging for preterm infants monitoring in Neonatal Intensive Care Units (NICU). Accurate detection of respiratory region of interest (Resp-RoI), e.g. thorax and abdomen of infants, is essential for achieving a fully-automatic solution and for high-quality RR estimation. However, the application of fast Fourier transform (FFT) for detecting Resp-RoI in premature infants may not be appropriate due to their irregular breathing patterns. This study proposes a new method for detecting Resp-RoIs in premature infants that uses time-domain features of angular-velocity of respiration. By fusing respiratory motion on orthogonal directions, the proposed method is more robust to variations of infant posture in the incubator.. In addition, using inter-beat interval (IBI) features in the time domain helps to distinguish between Resp-RoI and background. The proposed method was validated on 20 preterm infants in NICU. It obtains a clear improvement on Resp-RoI detection (RoI correspondence = 0.74) and RR estimation (MAE = 3.62 bpm) against the benchmarked approaches (maxFFT: RoI correspondence = 0.45, MAE = 5.61 bpm).
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Van Hove O, Andrianopoulos V, Dabach A, Debeir O, Van Muylem A, Leduc D, Legrand A, Ercek R, Feipel V, Bonnechère B. The use of time-of-flight camera to assess respiratory rates and thoracoabdominal depths in patients with chronic respiratory disease. THE CLINICAL RESPIRATORY JOURNAL 2023; 17:176-186. [PMID: 36710074 PMCID: PMC9978902 DOI: 10.1111/crj.13581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 12/20/2022] [Accepted: 12/23/2022] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Over the last 5 years, the analysis of respiratory patterns presents a growing usage in clinical and research purposes, but there is still currently a lack of easy-to-use and affordable devices to perform such kind of evaluation. OBJECTIVES The aim of this study is to validate a new specifically developed method, based on Kinect sensor, to assess respiratory patterns against spirometry under various conditions. METHODS One hundred and one participants took parts in one of the three validations studies. Twenty-five chronic respiratory disease patients (14 with chronic obstructive pulmonary disease (COPD) [65 ± 10 years old, FEV1 = 37 (15% predicted value), VC = 62 (20% predicted value)], and 11 with lung fibrosis (LF) [64 ± 14 years old, FEV1 = 55 (19% predicted value), VC = 62 (20% predicted value)]) and 76 healthy controls (HC) were recruited. The correlations between the signal of the Kinect (depth and respiratory rate) and the spirometer (tidal volume and respiratory rate) were computed in part 1. We then included 66 HC to test the ability of the system to detect modifications of respiratory patterns induced by various conditions known to modify respiratory pattern (cognitive load, inspiratory load and combination) in parts 2 and 3. RESULTS There is a strong correlation between the depth recorded by the Kinect and the tidal volume recorded by the spirometer: r = 0.973 for COPD patients, r = 0.989 for LF patients and r = 0.984 for HC. The Kinect is able to detect changes in breathing patterns induced by different respiratory disturbance conditions, gender and oral task. CONCLUSIONS Measurements performed with the Kinect sensors are highly correlated with the spirometer in HC and patients with COPD and LF. Kinect is also able to assess respiratory patterns under various loads and disturbances. This method is affordable, easy to use, fully automated and could be used in the current clinical context. Respiratory patterns are important to assess in daily clinics. However, there is currently no affordable and easy-to-use tool to evaluate these parameters in clinics. We validated a new system to assess respiratory patterns using the Kinect sensor in patients with chronic respiratory diseases.
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Affiliation(s)
| | - Vasileios Andrianopoulos
- Institute for Pulmonary Rehabilitation ResearchSchoen Klinik Berchtesgadener LandSchoenau am KoenigsseeGermany
| | - Ali Dabach
- LISA ‐ Laboratory of Image Synthesis and AnalysisUniversité Libre de BruxellesBrusselsBelgium
| | - Olivier Debeir
- LISA ‐ Laboratory of Image Synthesis and AnalysisUniversité Libre de BruxellesBrusselsBelgium
| | | | - Dimitri Leduc
- Department of PneumologyErasme HospitalBrusselsBelgium,Laboratory of Cardiorespiratory PhysiologyUniversité Libre de BruxellesBrusselsBelgium
| | - Alexandre Legrand
- Department of Respiratory Physiology, Pathophysiology and RehabilitationResearch Institute for Health Sciences and Technology, University of MonsMonsBelgium
| | - Rudy Ercek
- LISA ‐ Laboratory of Image Synthesis and AnalysisUniversité Libre de BruxellesBrusselsBelgium
| | - Véronique Feipel
- Laboratory of Functional AnatomyUniversité Libre de BruxellesBrusselsBelgium
| | - Bruno Bonnechère
- REVAL Rehabilitation Research Center, Faculty of Rehabilitation SciencesHasselt UniversityDiepenbeekBelgium,Technology‐Supported and Data‐Driven Rehabilitation, Data Sciences InstituteHasselt UniversityDiepenbeekBelgium
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Cavigioli F, Bresesti I, Gatto S, Castoldi F, Gavilanes D, Gazzolo D, Agosti M, Kramer B, Lista G. Different Settings of Nonsynchronized Bilevel Nasal Continuous Positive Airway Pressure and Respiratory Function in Preterm Infants: A Pilot Study. Am J Perinatol 2022; 39:S63-S67. [PMID: 36470293 DOI: 10.1055/s-0042-1758868] [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: 12/12/2022]
Abstract
OBJECTIVE With this study, we evaluated the short-term effects of different modes and settings of noninvasive respiratory support on gas exchange, breathing parameters, and thoracoabdominal synchrony in preterm infants in the acute phase of moderate respiratory distress syndrome. STUDY DESIGN A feasibility crossover trial was conducted in neonates < 32 weeks' gestation on nasal continuous positive airway pressure (n-CPAP) or bilevel n-CPAP. Infants were delivered the following settings in consecutive order for 10 minutes each: • n-CPAP (5 cm H2O) • bilevel n-CPAP 1 (Pres low = 5 cm H2O, Pres high = 7 cm H2O, T-high = 1 second, rate = 30/min) • n-CPAP (5 cm H2O) • bilevel n-CPAP 2 (Pres low = 5 cm H2O, Pres high = 7 cm H2O, T-high = 2 second, rate = 15/min) • n-CPAP (5 cm H2O). During each phase, physiologic parameters were recorded; the thoracoabdominal synchrony expressed by the phase angle (Φ) and other respiratory patterns were monitored by noncalibrated respiratory inductance plethysmography. RESULTS Fourteen preterm infants were analyzed. The mean CPAP level was significantly lower in the n-CPAP period compared with bilevel n-CPAP 1 and 2 (p = 0.03). Higher values were achieved with bilevel n-CPAP 2 (6.2 ± 0.6 vs. 5.7 ± 0.5 cm H2O, respectively; p < 0.05). No statistical difference in the Φ was detected, nor between the three settings. CONCLUSION Our study did not show any superiority of bilevel n-CPAP over n-CPAP. However, nonsynchronized bilevel n-CPAP might be helpful when additional pressure is needed. KEY POINTS · There is currently a high degree of uncertainty about the superiority of one modality and setting of noninvasive respiratory over another.. · Our study confirmed that non-synchronized bilevel n-CPAP might be helpful when additional pressure is needed for recruitment.. · A T-high of 1 second could possibly be better tolerated in this population, but further research is needed..
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Affiliation(s)
- Francesco Cavigioli
- Division of Neonatology, "V.Buzzi" Children's Hospital, ASST FBF-Sacco, Milan, Italy
| | - Ilia Bresesti
- Division of Neonatology, "V.Buzzi" Children's Hospital, ASST FBF-Sacco, Milan, Italy.,Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Sara Gatto
- Division of Neonatology, "V.Buzzi" Children's Hospital, ASST FBF-Sacco, Milan, Italy
| | - Francesca Castoldi
- Division of Neonatology, "V.Buzzi" Children's Hospital, ASST FBF-Sacco, Milan, Italy
| | - Danilo Gavilanes
- Department of Pediatrics, School for Oncology and Developmental Biology (GROW), Maastricht University Medical Center, Maastricht, The Netherlands
| | - Diego Gazzolo
- Neonatal Intensive Care Unit, G. D'Annunzio University, Chieti, Italy
| | - Massimo Agosti
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Boris Kramer
- Department of Pediatrics, School for Oncology and Developmental Biology (GROW), Maastricht University Medical Center, Maastricht, The Netherlands
| | - Gianluca Lista
- Division of Neonatology, "V.Buzzi" Children's Hospital, ASST FBF-Sacco, Milan, Italy
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Model-Base Estimation of Non-Invasive Ventilation Weaning of Preterm Infants Exposed to Osteopathic Manipulative Treatment: A Propensity-Score-Matched Cohort Study. Healthcare (Basel) 2022; 10:healthcare10122379. [PMID: 36553903 PMCID: PMC9777985 DOI: 10.3390/healthcare10122379] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 11/23/2022] [Accepted: 11/25/2022] [Indexed: 11/29/2022] Open
Abstract
Ventilation weaning is a key intensive care event influencing preterm infants’ discharge from a neonatal intensive care unit (NICU). Osteopathic manipulative treatment (OMT) has been recently introduced in some Italian NICUs. This retrospective cohort study tested if OMT is associated with faster non-invasive ventilation (NIV) weaning. The time to NIV weaning was assessed in very preterm and very low birth weight infants who either received or did not receive OMT. The propensity score model included gender, antenatal steroids, gestational age (GA), birth weight (BW), and Apgar score 5′. Out of 93 infants, 40 were included in the multilevel survival analysis, showing a reduction of time to NIV weaning for GA (HR: 2.58, 95%CI: 3.91 to 1.71, p < 0.001) and OMT (HR: 3.62, 95%CI: 8.13 to 1.61, p = 0.002). Time to independent ventilation (TIV) was modeled with GA and BW as dependent variables and OMT as the factor. A negative linear effect of GA and BW on TIV was shown. OMT exposure studied as the factor of GA had effects on TIV in infants born up to the 32nd gestational week. Preterm infants exposed to OMT were associated with earlier achievement of NIV weaning. This result, together with the demonstrated OMT safety, suggests the conduct of clinical trials in preterm infants younger than 32 weeks of GA.
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Zaltieri M, Massaroni C, Di Tocco J, Bravi M, Morrone M, Sterzi S, Caponero MA, Schena E, Lo Presti D. Preliminary Assessment of a Flexible Multi-Sensor Wearable System Based on Fiber Bragg Gratings for Respiratory Monitoring of Hemiplegic Patients. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13525. [PMID: 36294108 PMCID: PMC9603331 DOI: 10.3390/ijerph192013525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 09/23/2022] [Accepted: 10/18/2022] [Indexed: 06/16/2023]
Abstract
Respiratory diseases are common in post-stroke hemiplegic patients and represent a major social problem as they worsen the quality of life and reduce the life span. As a consequence, being able to monitor respiratory parameters such as the respiratory rate (RR) and assess the presence of respiratory asynchronies could be of paramount importance to define hemiplegics' health status. Moreover, RR is a useful parameter to investigate the level of fatigue and distress that these patients undergo during rehabilitation processes. Although motion capture systems and flowmeters are the leading instruments for respiratory pattern evaluation, smart wearable systems are gaining ever more acceptance since they allow continuous monitoring by detecting chest wall breathing displacements, ensuring reduced costs and no need for dedicated spaces. Among other sensing technologies, fiber Bragg grating (FBG) sensors have emerged thanks to their high sensitivity to strain, lightness, and multiplexing capability. In this work, a wearable system composed of four flexible dumbbell-shaped sensing modules is proposed for respiratory monitoring in hemiplegic patients. The system is light and easy to wear and can be adapted to any anthropometry thanks to the modular anchoring system. Its feasibility assessment in RR evaluation was performed on seven hemiplegic volunteers in eupnea and tachypnea breathing conditions. In addition, an explorative investigation was conducted to assess the system's ability to detect asynchronies between torso compartments. The good results suggest that this device could be a useful instrument to support clinicians and operators in hemiplegic patients' management.
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Affiliation(s)
- Martina Zaltieri
- Unit of Measurements and Biomedical Instrumentation, Università Campus Bio-Medico di Roma, 00128 Rome, Italy
| | - Carlo Massaroni
- Unit of Measurements and Biomedical Instrumentation, Università Campus Bio-Medico di Roma, 00128 Rome, Italy
| | - Joshua Di Tocco
- Unit of Measurements and Biomedical Instrumentation, Università Campus Bio-Medico di Roma, 00128 Rome, Italy
| | - Marco Bravi
- Unit of Physical and Rehabilitative Medicine, Università Campus Bio-Medico di Roma, 00128 Rome, Italy
| | - Michelangelo Morrone
- Unit of Physical and Rehabilitative Medicine, Università Campus Bio-Medico di Roma, 00128 Rome, Italy
| | - Silvia Sterzi
- Unit of Physical and Rehabilitative Medicine, Università Campus Bio-Medico di Roma, 00128 Rome, Italy
| | | | - Emiliano Schena
- Unit of Measurements and Biomedical Instrumentation, Università Campus Bio-Medico di Roma, 00128 Rome, Italy
| | - Daniela Lo Presti
- Unit of Measurements and Biomedical Instrumentation, Università Campus Bio-Medico di Roma, 00128 Rome, Italy
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Higashino M, Miyata K, Kudo K. Coordination dynamics of thoracic and abdominal movements during voluntary breathing. Sci Rep 2022; 12:13266. [PMID: 35918415 PMCID: PMC9345990 DOI: 10.1038/s41598-022-17473-9] [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: 09/06/2021] [Accepted: 07/26/2022] [Indexed: 11/15/2022] Open
Abstract
Thoracic and abdominal movements can be tightly coupled during voluntary breathing, such as when singing and playing wind instruments. The present study investigated the coordination of thoracic and abdominal movements during voluntary breathing using a dynamical systems approach. We examined whether there are two stable coordination patterns, and if the coordination pattern would abruptly change when the breathing frequency increased, which is known as phase transition. The participants inhaled and exhaled repeatedly at 7.5, 15, 30, 60, or 120 breaths per minute. At the beginning and end of the experiment, the participants performed breathing at their preferred frequency. As a result, the coordination pattern at the lower and preferred frequencies exhibited an in-phase pattern. When breathing frequency increased, participants showed deviated coordination patterns from the in-phase pattern to either a thoracic-leading pattern, an abdominal-leading pattern, or an anti-phase pattern depending on the individual. These deviations occurred gradually; thus, phase transition was not observed. Our findings suggest that thoracic and abdominal movements are tightly coupled at lower frequencies, but their patterns vary depending on the breathing frequency and individuals. Therefore, the present study suggests the importance of viewing breath control in terms of coordination of thoracic and abdominal movements.
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Affiliation(s)
- Mimu Higashino
- Graduate School of Interdisciplinary Information Studies, The University of Tokyo, 3-8-1, Komaba, Meguro, Tokyo, 153-8902, Japan
| | - Kohei Miyata
- Graduate School of Arts and Sciences, The University of Tokyo, 3-8-1, Komaba, Meguro, Tokyo, 153-8902, Japan.
| | - Kazutoshi Kudo
- Graduate School of Interdisciplinary Information Studies, The University of Tokyo, 3-8-1, Komaba, Meguro, Tokyo, 153-8902, Japan. .,Graduate School of Arts and Sciences, The University of Tokyo, 3-8-1, Komaba, Meguro, Tokyo, 153-8902, Japan.
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11
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Ryu G, Kim HY, Choi JH. Associations of respiratory mechanic instability with respiratory parameters in pediatric patients with obstructive sleep apnea syndrome. Int J Pediatr Otorhinolaryngol 2022; 159:111208. [PMID: 35728462 DOI: 10.1016/j.ijporl.2022.111208] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 04/25/2022] [Accepted: 06/09/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVES This study aimed to identify the effectiveness of respiratory mechanic instability (RMI) in the diagnosis of pediatric obstructive sleep apnea syndrome (OSAS). We sought to evaluate the correlations of RMI with sleep-related parameters and determine the effectiveness of using RMI for diagnosing OSAS in children. METHODS Children who underwent polysomnography (PSG) for various reasons were enrolled in this study. Patients' clinical and PSG data at two university hospitals were reviewed retrospectively. During PSG, RMI parameters were automatically calculated according to the phase relationship between thoracic and abdominal movement signals. RESULTS Among 263 children who underwent PSG, 183 (70.4%) were diagnosed with OSAS (apnea-hypopnea index [AHI] ≥ 1). RMI parameters were higher in the OSAS group than in the control group. They also tended to increase with disease severity. RMI scores were well correlated with respiratory parameters, showing a stronger correlation in those with moderate or severe OSAS without central apnea. Areas under the receiver operating characteristics curves (AUROCs) of RMI indicators were over 0.65. The percentage of RMI in stage duration showed the highest value of the AUROCs. CONCLUSION Paradoxical thoraco-abdominal movement assessed by RMI provides additional information. It may be useful in diagnosing OSAS in children.
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Affiliation(s)
- Gwanghui Ryu
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
| | - Hyo Yeol Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
| | - Ji Ho Choi
- Department of Otorhinolaryngology-Head and Neck Surgery, Soonchunhyang University College of Medicine, Bucheon Hospital, Bucheon, Gyeonggi-do, Republic of Korea.
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12
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Decuzzi J, Redline S, Isaiah A. Secondary Analyses of the Childhood Adenotonsillectomy Trial: A Narrative Review. JAMA Otolaryngol Head Neck Surg 2022; 148:779-784. [PMID: 35737366 DOI: 10.1001/jamaoto.2022.1330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Adenotonsillectomy, performed for approximately 500 000 children annually in the US alone, is the first line of treatment of pediatric obstructive sleep apnea (OSA). The Childhood Adenotonsillectomy Trial (CHAT), the first randomized clinical trial to test the efficacy of adenotonsillectomy, compared the management of pediatric nonsevere OSA by early adenotonsillectomy (eAT) vs watchful waiting with supportive care. Since the publication of the primary article in 2013, the CHAT study data set were made available via the National Sleep Research Resource, which allowed researchers to address a range of additional clinical questions relevant to the care of children with OSA. This review focuses on secondary analyses associated with the CHAT data set as grouped by the outcome of interest. Observations The results of most secondary analyses suggest that children who underwent eAT experienced the greatest improvements in symptom burden, sleepiness, parent-reported behavior, and quality of life. Changes in other domains, such as cognition, cardiovascular physiology, and metabolic indicators, were modest and selective. The associations between most treatment outcomes and polysomnographic parameters were weak. Symptoms were poor predictors of OSA severity. The results from these secondary analyses benefitted from the rigor of multicenter design and centralized polysomnography interpretation in CHAT. However, the exclusion of younger preschool-aged children and children with primary snoring limited the generalizability of findings. In addition, because caregivers were not masked, some of the parent-reported outcomes may have been inflated. Conclusions and Relevance The results of this narrative review suggest that CHAT provides a model for future OSA-related studies in children for design, conduct, and subsequent reuse of the study data set, and its findings have advanced our understanding of the pathophysiology and management of pediatric nonsevere OSA. Directions for future research include whether the findings from this landmark study are generalizable to younger children and children with primary snoring and severe OSA. Similar studies may help address practice variability associated with pediatric OSA and help identify children who are most likely to benefit from undergoing eAT.
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Affiliation(s)
- Julianna Decuzzi
- University of Maryland Medical Center, Department of Otorhinolaryngology-Head and Neck Surgery, Baltimore
| | - Susan Redline
- Division of Sleep Medicine and Circadian Disorders, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.,Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Amal Isaiah
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Maryland School of Medicine, Baltimore.,Department of Pediatrics, University of Maryland School of Medicine, Baltimore.,Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore
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13
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Silva L, Dias M, Folgado D, Nunes M, Namburi P, Anthony B, Carvalho D, Carvalho M, Edelman E, Gamboa H. Respiratory Inductance Plethysmography to Assess Fatigability during Repetitive Work. SENSORS 2022; 22:s22114247. [PMID: 35684868 PMCID: PMC9185634 DOI: 10.3390/s22114247] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Revised: 05/27/2022] [Accepted: 05/30/2022] [Indexed: 11/16/2022]
Abstract
Cumulative fatigue during repetitive work is associated with occupational risk and productivity reduction. Usually, subjective measures or muscle activity are used for a cumulative evaluation; however, Industry 4.0 wearables allow overcoming the challenges observed in those methods. Thus, the aim of this study is to analyze alterations in respiratory inductance plethysmography (RIP) to measure the asynchrony between thorax and abdomen walls during repetitive work and its relationship with local fatigue. A total of 22 healthy participants (age: 27.0 ± 8.3 yrs; height: 1.72 ± 0.09 m; mass: 63.4 ± 12.9 kg) were recruited to perform a task that includes grabbing, moving, and placing a box in an upper and lower shelf. This task was repeated for 10 min in three trials with a fatigue protocol between them. Significant main effects were found from Baseline trial to the Fatigue trials (p < 0.001) for both RIP correlation and phase synchrony. Similar results were found for the activation amplitude of agonist muscle (p < 0.001), and to the muscle acting mainly as a joint stabilizer (p < 0.001). The latter showed a significant effect in predicting both RIP correlation and phase synchronization. Both RIP correlation and phase synchronization can be used for an overall fatigue assessment during repetitive work.
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Affiliation(s)
- Luís Silva
- Laboratório de Instrumentação, Engenharia Biomédica e Física da Radiação (LIBPhys-UNL), Departamento de Física, Faculdade de Ciências e Tecnologia, Universidade Nova de Lisboa, 2829-516 Caparica, Portugal; (M.D.); (D.F.); (H.G.)
- Correspondence:
| | - Mariana Dias
- Laboratório de Instrumentação, Engenharia Biomédica e Física da Radiação (LIBPhys-UNL), Departamento de Física, Faculdade de Ciências e Tecnologia, Universidade Nova de Lisboa, 2829-516 Caparica, Portugal; (M.D.); (D.F.); (H.G.)
| | - Duarte Folgado
- Laboratório de Instrumentação, Engenharia Biomédica e Física da Radiação (LIBPhys-UNL), Departamento de Física, Faculdade de Ciências e Tecnologia, Universidade Nova de Lisboa, 2829-516 Caparica, Portugal; (M.D.); (D.F.); (H.G.)
- Associação Fraunhofer Portugal Research, Rua Alfredo Allen 455/461, 4200-135 Porto, Portugal;
| | - Maria Nunes
- Associação Fraunhofer Portugal Research, Rua Alfredo Allen 455/461, 4200-135 Porto, Portugal;
| | - Praneeth Namburi
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA 02139, USA; (P.N.); (B.A.); (E.E.)
- MIT.nano Immersion Lab, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Brian Anthony
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA 02139, USA; (P.N.); (B.A.); (E.E.)
- Device Realization Laboratory, Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Diogo Carvalho
- Faculty of Medicine, Rīga Stradiņš University, 16 Dzirciema iela, LV-1007 Rīga, Latvia;
| | - Miguel Carvalho
- Campus de Azurém, Minho University, 4800-058 Guimarães, Portugal;
| | - Elazer Edelman
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA 02139, USA; (P.N.); (B.A.); (E.E.)
- Brigham and Women’s Hospital, Cardiovascular Division, 75 Francis Street, Boston, MA 02115, USA
| | - Hugo Gamboa
- Laboratório de Instrumentação, Engenharia Biomédica e Física da Radiação (LIBPhys-UNL), Departamento de Física, Faculdade de Ciências e Tecnologia, Universidade Nova de Lisboa, 2829-516 Caparica, Portugal; (M.D.); (D.F.); (H.G.)
- Associação Fraunhofer Portugal Research, Rua Alfredo Allen 455/461, 4200-135 Porto, Portugal;
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14
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Mohan V, Branney J, Clark C, Neal R, Jagannathan M, Paungmali A, Perri M. Reliability and preliminary reference values for the Total Faulty Breathing Scale (TFBS): A cross-sectional study. Health Sci Rep 2022; 5:e661. [PMID: 35620546 PMCID: PMC9128177 DOI: 10.1002/hsr2.661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 05/07/2022] [Accepted: 05/11/2022] [Indexed: 11/09/2022] Open
Abstract
Background and Aims The evaluation of breathing function is crucial in the clinical examination of the respiratory system. The Total Faulty Breathing Scale (TFBS) could be used in clinical settings to quantify the measurement of breathing dysfunction. Reliability data for the TFBS are available for males, but there is a requirement to determine reliability for females and to develop reference values. The aim of this study, therefore, was to determine the reliability in females and to establish the preliminary reference values for the TFBS. Methods Twenty-three healthy female participants for reliability and 44 (7 male and 37 female) participants for preliminary reference values participated in this cross-sectional study. For both aspects of the study, participants were instructed to breathe at their own pace with no specific instruction. Then each participant was observed carrying out normal breathing for a period of 10 breaths and deep breathing for a period of 10 breaths while being assessed with the TFBS. Results Intrarater and interrater reliability of the TFBS showed a kappa value of 0.769 and 0.751, respectively, indicating substantial agreement for female participants. The preliminary reference categories for TFBS were reported to be normal for 20 (45.5%) participants and mild faulty breathing for the remaining 24 (54.4%) participants. Conclusions The findings of this study suggested that TFBS was reliable to measure breathing function among female participants, and the reference categories may be helpful in the identification of normal and faulty breathing.
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Affiliation(s)
- Vikram Mohan
- Department of Rehabilitation and Sports Sciences, Faculty of Health and Social Sciences Bournemouth University Bournemouth UK
| | - Jonathan Branney
- Department of Nursing Science, Faculty of Health and Social Sciences Bournemouth University Bournemouth UK
| | - Carol Clark
- Department of Rehabilitation and Sports Sciences, Faculty of Health and Social Sciences Bournemouth University Bournemouth UK
| | - Rebecca Neal
- Department of Rehabilitation and Sports Sciences, Faculty of Health and Social Sciences Bournemouth University Bournemouth UK
| | | | - Aatit Paungmali
- Neuro-Musculoskeletal and Pain Research Unit, Department of Physical Therapy, Faculty of Associated Medical Sciences Chiang Mai University Chiang Mai Thailand
| | - Maria Perri
- Perri Chiropractic, Wellness Springs Highland Mills New York USA
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15
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Dassios T, Vervenioti A, Dimitriou G. Respiratory muscle function in the newborn: a narrative review. Pediatr Res 2022; 91:795-803. [PMID: 33875805 PMCID: PMC8053897 DOI: 10.1038/s41390-021-01529-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 03/24/2021] [Accepted: 03/29/2021] [Indexed: 02/02/2023]
Abstract
Our aim was to summarise the current evidence and methods used to assess respiratory muscle function in the newborn, focusing on current and future potential clinical applications. The respiratory muscles undertake the work of breathing and consist mainly of the diaphragm, which in the newborn is prone to dysfunction due to lower muscle mass, flattened shape and decreased content of fatigue-resistant muscle fibres. Premature infants are prone to diaphragmatic dysfunction due to limited reserves and limited capacity to generate force and avoid fatigue. Methods to assess the respiratory muscles in the newborn include electromyography, maximal respiratory pressures, assessment for thoraco-abdominal asynchrony and composite indices, such as the pressure-time product and the tension time index. Recently, there has been significant interest and a growing body of research in assessing respiratory muscle function using bedside ultrasonography. Neurally adjusted ventilator assist is a novel ventilation mode, where the level of the respiratory support is determined by the diaphragmatic electrical activity. Prolonged mechanical ventilation, hypercapnia and hypoxia, congenital anomalies and systemic or respiratory infection can negatively impact respiratory muscle function in the newborn, while caffeine and synchronised or volume-targeted ventilation have a positive effect on respiratory muscle function compared to conventional, non-triggered or pressure-limited ventilation, respectively. IMPACT: Respiratory muscle function is impaired in prematurely born neonates and infants with congenital anomalies, such as congenital diaphragmatic hernia. Respiratory muscle function is negatively affected by prolonged ventilation and infection and positively affected by caffeine and synchronised compared to non-synchronised ventilation modes. Point-of-care diaphragmatic ultrasound and neurally adjusted ventilator assist are recent diagnostic and therapeutic technological developments with significant clinical applicability.
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Affiliation(s)
- Theodore Dassios
- Department of Women and Children's Health, King's College London, London, UK. .,Department of Paediatrics, University of Patras, Patras, Greece.
| | - Aggeliki Vervenioti
- grid.11047.330000 0004 0576 5395Department of Paediatrics, University of Patras, Patras, Greece
| | - Gabriel Dimitriou
- grid.11047.330000 0004 0576 5395Department of Paediatrics, University of Patras, Patras, Greece
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16
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Abstract
Avoiding MV is a critical goal in neonatal respiratory care. Different modes of noninvasive respiratory support beyond nasal CPAP, such as nasal intermittent positive pressure ventilation (NIPPV) and synchronized NIPPV (SNIPPV), may further reduce intubation rates. SNIPPV offers consistent benefits over nonsynchronized techniques such as a more efficient positive pressure transmission to the lung, an effective increase in transpulmonary pressure during ventilation, and a better stabilization of the chest wall during inspiration. This review discusses mechanisms of action, benefits and limitations of synchronized noninvasive ventilation, describes the different modes of synchronization, and analyzes properties and clinical results.
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Affiliation(s)
- Corrado Moretti
- Department of Paediatrics, Policlinico Umberto I, Sapienza University of Rome, Viale Regina Elena 324, Rome 00185, Italy
| | - Camilla Gizzi
- Paediatric and Neonatology Unit, "Sandro Pertini" Hospital, Via Monti Tiburtini 385, Rome 00157, Italy.
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17
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Ratnagiri MV, Zhu Y, Rahman T, Theroux M, Tomatsu S, Shaffer TH. Automated Assessment of Thoracic-Abdominal Asynchrony in Patients with Morquio Syndrome. Diagnostics (Basel) 2021; 11:diagnostics11050880. [PMID: 34063456 PMCID: PMC8156300 DOI: 10.3390/diagnostics11050880] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 05/11/2021] [Accepted: 05/12/2021] [Indexed: 11/29/2022] Open
Abstract
Morquio syndrome is a rare disease caused by a disorder in the storage of mucopolysaccharides that affects multiple organs, including musculoskeletal, respiratory, cardiovascular, and digestive systems. Respiratory failure is one of the leading causes of mortality in Morquio patients; thus, respiratory function testing is vital to the management of the disease. An automated respiratory assessment methodology using the pneuRIP device and a machine-learning algorithm was developed. pneuRIP is a noninvasive approach that uses differences between thoracic and abdominal movements (thoracic-abdominal asynchrony) during respiration to assess respiratory status. The technique was evaluated on 17 patients with Morquio (9 females and 8 males) between the ages of 2 and 57 years. The results of the automated technique agreed with the clinical assessment in 16 out of the 17 patients. It was found that the inverse cumulative percentage representation of the time delay between the thorax and abdomen was the most critical variable for accurate evaluation. It was demonstrated that the technique could be successfully used on patients with Morquio who have difficulty breathing with 100% compliance. This technique is highly accurate, portable, noninvasive, and easy to administer, making it suitable for a variety of settings, such as outpatient clinics, at home, and emergency rooms.
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Affiliation(s)
| | - Yan Zhu
- Nemours Biomedical Research, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE 19803, USA; (Y.Z.); (T.R.); (S.T.)
| | - Tariq Rahman
- Nemours Biomedical Research, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE 19803, USA; (Y.Z.); (T.R.); (S.T.)
| | - Mary Theroux
- Department of Anesthesiology and Perioperative Medicine & Nemours Biomedical Research, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE 19803, USA;
| | - Shunji Tomatsu
- Nemours Biomedical Research, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE 19803, USA; (Y.Z.); (T.R.); (S.T.)
- Department of Pediatrics, Gifu University, Gifu 501-1193, Japan
- Department of Pediatrics, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Thomas H. Shaffer
- Nemours Biomedical Research, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE 19803, USA; (Y.Z.); (T.R.); (S.T.)
- Department of Pediatrics, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA 19107, USA
- Center for Pediatric Lung Research, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE 19803, USA
- Department of Physiology and Pediatrics, Lewis Katz School of Medicine at Temple University, Philadelphia, PA 19140, USA
- Correspondence: ; Tel.: +1-302-651-6837
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18
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Azevedo IG, Peres AL, Moran CA, de Oliveira Holanda NS, Gomes DC, Pereira SA. Relationship between thoracoabdominal mobility and hours of life in infants: A cross-sectional study. Respir Physiol Neurobiol 2021; 290:103676. [PMID: 33910080 DOI: 10.1016/j.resp.2021.103676] [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: 01/07/2021] [Revised: 03/29/2021] [Accepted: 04/21/2021] [Indexed: 11/27/2022]
Abstract
Assessing the relationship between thoracoabdominal mobility (TAM) in newborns (NBs) is relevant for a greater understanding of pulmonary kinematics. This study aimed to assess the association between TAM, hours of life and respiratory rate (RR) in term NBs. Healthy NBs were included in the sample. They were filmed for 2 min, with markers in the lateral region of the trunk, delimiting the thoracic and abdominal areas. TAM and RR were assessed using a MATLAB® routine. For kinematic analysis, an algorithm created graphs presenting thoracoabdominal mobility. A total of 26 NBs were evaluated. TAM was the only variable that exhibited a statistically significant intergroup difference, showing that the fewer the hours of life, the greater the mobility. Simple linear regression analysis showed that RR can explain 31% of the variation in abdominal mobility (p = 0.002). Thus, the fewer the hours of life, the greater the TAM of NBs, with a predominance of abdominal compartment mobility.
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Affiliation(s)
| | - Ana Lorena Peres
- Faculty of Health Sciences, Federal University of Rio Grande do Norte (FACISA - UFRN), Santa Cruz, Brazil
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19
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Santana PV, Cardenas LZ, Ferreira JG, de Carvalho CRR, de Albuquerque ALP, Caruso P. Thoracoabdominal asynchrony associates with exercise intolerance in fibrotic interstitial lung diseases. Respirology 2021; 26:673-682. [PMID: 33860975 DOI: 10.1111/resp.14064] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Revised: 02/07/2021] [Accepted: 03/31/2021] [Indexed: 01/19/2023]
Abstract
BACKGROUND AND OBJECTIVE The precise coordination of respiratory muscles during exercise minimizes work of breathing and avoids exercise intolerance. Fibrotic interstitial lung disease (f-ILD) patients are exercise-intolerant. We assessed whether respiratory muscle incoordination and thoracoabdominal asynchrony (TAA) occur in f-ILD during exercise, and their relationship with pulmonary function and exercise performance. METHODS We compared breathing pattern, respiratory mechanics, TAA and respiratory muscle recruitment in 31 f-ILD patients and 31 healthy subjects at rest and during incremental cycle exercise. TAA was defined as phase angle (PhAng) >20°. RESULTS During exercise, when compared with controls, f-ILD patients presented increased and early recruitment of inspiratory rib cage muscle (p < 0.05), and an increase in PhAng, indicating TAA. TAA was more frequent in f-ILD patients than in controls, both at 50% of the maximum workload (42.3% vs. 10.7%, p = 0.01) and at the peak (53.8% vs. 23%, p = 0.02). Compared with f-ILD patients without TAA, f-ILD patients with TAA had lower lung volumes (forced vital capacity, p < 0.01), greater dyspnoea (Medical Research Council > 2 in 64.3%, p = 0.02), worse exercise performance (lower maximal work rate % predicted, p = 0.03; lower tidal volume, p = 0.03; greater desaturation and dyspnoea, p < 0.01) and presented higher oesophageal inspiratory pressures with lower gastric inspiratory pressures and higher recruitment of scalene (p < 0.05). CONCLUSION Exercise induces TAA and higher recruitment of inspiratory accessory muscle in ILD patients. TAA during exercise occurred in more severely restricted ILD patients and was associated with exertional dyspnoea, desaturation and limited exercise performance.
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Affiliation(s)
- Pauliane Vieira Santana
- Pulmonary Division, Heart Institute (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.,Intensive Care Unit, AC Camargo Cancer Center, São Paulo, Brazil
| | - Leticia Zumpano Cardenas
- Pulmonary Division, Heart Institute (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.,Intensive Care Unit, AC Camargo Cancer Center, São Paulo, Brazil
| | - Jeferson George Ferreira
- Pulmonary Division, Heart Institute (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.,Intensive Care Unit, AC Camargo Cancer Center, São Paulo, Brazil
| | - Carlos Roberto Ribeiro de Carvalho
- Pulmonary Division, Heart Institute (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - André Luis Pereira de Albuquerque
- Pulmonary Division, Heart Institute (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.,Sírio-Libanês Teaching and Research Institute, Hospital Sírio Libanês, São Paulo, SP, Brazil
| | - Pedro Caruso
- Pulmonary Division, Heart Institute (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.,Intensive Care Unit, AC Camargo Cancer Center, São Paulo, Brazil
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20
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Ratnagiri MV, Ryan L, Strang A, Heinle R, Rahman T, Shaffer TH. Machine learning for automatic identification of thoracoabdominal asynchrony in children. Pediatr Res 2021; 89:1232-1238. [PMID: 32620007 PMCID: PMC10843835 DOI: 10.1038/s41390-020-1032-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 04/30/2020] [Accepted: 06/01/2020] [Indexed: 11/08/2022]
Abstract
BACKGROUND The current methods for assessment of thoracoabdominal asynchrony (TAA) require offline analysis on the part of physicians (respiratory inductance plethysmography (RIP)) or require experts for interpretation of the data (sleep apnea detection). METHODS To assess synchrony between the thorax and abdomen, the movements of the two compartments during quiet breathing were measured using pneuRIP. Fifty-one recordings were obtained: 20 were used to train a machine-learning (ML) model with elastic-net regularization, and 31 were used to test the model's performance. Two feature sets were explored: (1) phase difference (ɸ) between the thoracic and abdominal signals and (2) inverse cumulative percentage (ICP), which is an alternate measure of data distribution. To compute accuracy of training, the model outcomes were compared with five experts' assessments. RESULTS Accuracies of 61.3% and 90.3% were obtained using ɸ and ICP features, respectively. The inter-rater reliability (i.r.r.) of the assessments of experts was 0.402 and 0.684 when they used ɸ and ICP to identify TAA, respectively. CONCLUSIONS With this pilot study, we show the efficacy of the ICP feature and ML in developing an accurate automated approach to identifying TAA that reduces time and effort for diagnosis. ICP also helped improve consensus among experts. IMPACT Our article presents an automated approach to identifying thoracic abdominal asynchrony using machine learning and the pneuRIP device. It also shows how a modified statistical measure of cumulative frequency can be used to visualize the progression of the pulmonary functionality along time. The pulmonary testing method we developed gives patients and doctors a noninvasive and easy to administer and diagnose approach. It can be administered remotely, and alerts can be transmitted to the physician. Further, the test can also be used to monitor and assess pulmonary function continuously for prolonged periods, if needed.
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Affiliation(s)
- Madhavi V Ratnagiri
- Biomedical Research, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, USA
| | - Lauren Ryan
- Biomedical Research, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, USA
| | - Abigail Strang
- Division of Pulmonary Medicine, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, USA
| | - Robert Heinle
- Division of Pulmonary Medicine, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, USA
| | - Tariq Rahman
- Biomedical Research, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, USA
| | - Thomas H Shaffer
- Biomedical Research, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, USA.
- Center for Pediatric Lung Research, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, USA.
- Department of Pediatrics, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA.
- Department of Physiology and Pediatrics, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA.
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21
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LoMauro A, Aliverti A, Perchiazzi G, Frykholm P. Physiological changes and compensatory mechanisms by the action of respiratory muscles in a porcine model of phrenic nerve injury. J Appl Physiol (1985) 2021; 130:813-826. [PMID: 33444121 DOI: 10.1152/japplphysiol.00781.2020] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Phrenic nerve damage may occur as a complication of specific surgical procedures, prolonged mechanical ventilation, or physical trauma. The consequent diaphragmatic paralysis or dysfunction can lead to major complications. The purpose of this study was to elucidate the role of the nondiaphragmatic respiratory muscles during partial or complete diaphragm paralysis induced by unilateral and bilateral phrenic nerve damage at different levels of ventilatory pressure support in an animal model. Ten pigs were instrumented, the phrenic nerve was exposed from the neck, and spontaneous respiration was preserved at three levels of pressure support, namely, high, low, and null, at baseline condition, after left phrenic nerve damage, and after bilateral phrenic nerve damage. Breathing pattern, thoracoabdominal volumes and asynchrony, and pressures were measured at each condition. Physiological breathing was predominantly diaphragmatic and homogeneously distributed between right and left sides. After unilateral damage, the paralyzed hemidiaphragm was passively dragged by the ipsilateral rib cage muscles and the contralateral hemidiaphragm. After bilateral damage, the drive to and the work of breathing of rib cage and abdominal muscles increased, to compensate for diaphragmatic paralysis, ensuing paradoxical thoracoabdominal breathing. Increasing level of pressure support ventilation replaces this muscle group compensation. When the diaphragm is paralyzed (unilaterally and/or bilaterally), there is a coordinated reorganization of nondiaphragmatic respiratory muscles as compensation that might be obscured by high level of pressure support ventilation. Noninvasive thoracoabdominal volume and asynchrony assessment could be useful in phrenic nerve-injured patients to estimate the extent and type of inspiratory muscle dysfunction.NEW & NOTEWORTHY This was the first (to our knowledge) implanted porcine model of phrenic nerve injury with a detailed multidimensional analysis of different degrees of diaphragmatic paralysis (unilateral and bilateral). Noninvasive thoracoabdominal volume and asynchrony assessment was shown to be useful in estimating the extent of diaphragmatic dysfunction and the consequent coordinated reorganization of nondiaphragmatic respiratory muscles. High level of pressure support ventilation was proved to obscure the interaction and compensation of respiratory muscles to deal with phrenic nerve injury.
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Affiliation(s)
- Antonella LoMauro
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milan, Italy.,Section of Anaesthesiology and Intensive Care, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Andrea Aliverti
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milan, Italy
| | - Gaetano Perchiazzi
- Section of Anaesthesiology and Intensive Care, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.,Hedenstierna Laboratory, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Peter Frykholm
- Section of Anaesthesiology and Intensive Care, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
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Kruapanich C, Tantisuwat A, Thaveeratitham P, Lertmaharit S, Ubolnuar N, Chimpalee J, Mathiyakom W. The effect of unsupported arm elevations on regional chest wall volumes and thoracoabdominal asynchrony in patients with chronic obstructive pulmonary disease. Physiother Theory Pract 2021; 38:1602-1614. [PMID: 33555228 DOI: 10.1080/09593985.2021.1882018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Objective: To compare the effect of unsupported arm elevation (UAE) in different planes on chest wall volumes, thoracoabdominal asynchrony (TAA), ventilatory demands, dyspnea, and arm fatigue in patients with chronic obstructive pulmonary disease (COPD) and healthy subjects. Methods: Twenty-one patients with COPD and healthy-matched subjects performed UAE in shoulder flexion, scaption, abduction, and resting. Pulmonary total and regional chest wall volumes (VRCp), abdominal rib cage volume, abdominal volume, TAA, and ventilatory demands during arm positions were measured using optoelectronic plethysmography. Results: In both groups, VRCp and TAA were significantly affected during UAEs compared with the resting position. The healthy subjects had significantly decreased VRCp (L) (p < 0.05) during scaption (0.14 ± 0.07) and abduction (0.15 ± 0.06) than during flexion (0.18 ± 0.07) and no significantly different TAA between UAEs. The COPD group had no significantly different VRCp between UAEs, had significantly increased TAA (p < 0.05) during scaption (31.1°±9.5°) and abduction (32.3°±9.9°) than during flexion (29.7°±9.1°); and had significantly worse VRCp (p = 0.007), TAA (p = 0.0001), ventilatory demands (p < 0.05), dyspnea ((p = 0.03), and arm fatigue (p = 0.002). Conclusions: In patients with COPD, UAE in different planes similarly restricted the upper chest wall volume. Shoulder scaption and abduction significantly impaired TAA, ventilation, dyspnea, and arm fatigue compared with flexion. These results may help to select the appropriate UAE during physical activities.
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Affiliation(s)
- Chathipat Kruapanich
- Department of Physical Therapy, Faculty of Allied Health Sciences, Chulalongkorn University, Pathumwan, Bangkok, Thailand
| | - Anong Tantisuwat
- Department of Physical Therapy, Faculty of Allied Health Sciences, Chulalongkorn University, Pathumwan, Bangkok, Thailand
| | - Premtip Thaveeratitham
- Department of Physical Therapy, Faculty of Allied Health Sciences, Chulalongkorn University, Pathumwan, Bangkok, Thailand
| | - Somrat Lertmaharit
- Department of Preventive and Social Medicine, Faculty of Medicine, Chulalongkorn University, Pathumwan, Bangkok, Thailand
| | - Nutsupa Ubolnuar
- Department of Physical Therapy, Faculty of Allied Health Sciences, Chulalongkorn University, Pathumwan, Bangkok, Thailand
| | - Jaturong Chimpalee
- Department of Physical Therapy and Rehabilitation, Central Chest Institute of Thailand, Nonthaburi, Thailand
| | - Witaya Mathiyakom
- Department of Physical Therapy, California State University, Northridge, Northridge, CA USA
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Rehouma H, Noumeir R, Essouri S, Jouvet P. Advancements in Methods and Camera-Based Sensors for the Quantification of Respiration. SENSORS (BASEL, SWITZERLAND) 2020; 20:E7252. [PMID: 33348827 PMCID: PMC7766256 DOI: 10.3390/s20247252] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Revised: 12/09/2020] [Accepted: 12/15/2020] [Indexed: 01/22/2023]
Abstract
Assessment of respiratory function allows early detection of potential disorders in the respiratory system and provides useful information for medical management. There is a wide range of applications for breathing assessment, from measurement systems in a clinical environment to applications involving athletes. Many studies on pulmonary function testing systems and breath monitoring have been conducted over the past few decades, and their results have the potential to broadly impact clinical practice. However, most of these works require physical contact with the patient to produce accurate and reliable measures of the respiratory function. There is still a significant shortcoming of non-contact measuring systems in their ability to fit into the clinical environment. The purpose of this paper is to provide a review of the current advances and systems in respiratory function assessment, particularly camera-based systems. A classification of the applicable research works is presented according to their techniques and recorded/quantified respiration parameters. In addition, the current solutions are discussed with regards to their direct applicability in different settings, such as clinical or home settings, highlighting their specific strengths and limitations in the different environments.
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Affiliation(s)
- Haythem Rehouma
- École de Technologie Supérieure, Montreal, QC H3T 1C5, Canada;
| | - Rita Noumeir
- École de Technologie Supérieure, Montreal, QC H3T 1C5, Canada;
| | - Sandrine Essouri
- CHU Sainte-Justine, Montreal, QC H3T 1C5, Canada; (S.E.); (P.J.)
| | - Philippe Jouvet
- CHU Sainte-Justine, Montreal, QC H3T 1C5, Canada; (S.E.); (P.J.)
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Ribeiro SNS, Lourenço LB, Sena GDS, Sampaio SSS, Pereira SA. Interação toracoabdominal e sua relação com os fatores de risco biológico em recém-nascidos prematuros. FISIOTERAPIA E PESQUISA 2020. [DOI: 10.1590/1809-2950/19011927022020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
RESUMO O objetivo do estudo foi avaliar a participação toracoabdominal durante a respiração e sua relação com os fatores de risco clínicos em recém-nascidos prematuros (RNPT). Trata-se de um estudo multicêntrico, transversal, realizado em duas unidades de cuidado intermediário neonatal com RNPT entre 26-35 semanas, estáveis hemodinamicamente, que fizeram uso de oxigênio ou suporte ventilatório durante a fase da internação. O movimento lateral do tronco foi filmado por 2 minutos e os vídeos foram avaliados no software MATLAB® para interpretação quantitativa da participação toracoabdominal, por um pesquisador cego sobre os dados da amostra. Os dados foram expressos graficamente em cm2 representando os valores máximos, mínimos e médios da participação de tórax e abdômen. O coeficiente de Pearson foi usado para avaliar a correlação entre as variáveis neonatais com a mobilidade. Foram avaliados 2.080 frames de 26 RNPT com idade gestacional média de 31 semanas ±2,34. Quanto maior a idade e o peso, maior a participação do tórax na respiração (r=0,55; p=0,001); e quanto maior o tempo de internação, menor é a sua participação (r=-0,40; p=0,04). A participação do abdômen aumenta de acordo com o aumento do número de dias em uso de oxigênio (r=0,33; p=0,001) e diminui com o aumento da idade e do peso (r=-0,41; p=0,001). A participação toracoabdominal tem relação direta com a idade gestacional e o peso. Como fatores externos, o uso prolongado de oxigênio e o tempo de internação interferem negativamente no padrão respiratório, uma vez que o aumento da participação abdominal durante a biomecânica respiratória pode representar um gasto energético.
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Gomes DC, Azevedo IG, de Figueiredo Araújo AG, da Costa Lopes LD, Nagem DAP, Magalhães FA, Pereira SA. Thoracoabdominal motion in newborns: Reliability between two interactive computing environments. Pediatr Pulmonol 2020; 55:1184-1189. [PMID: 32168420 DOI: 10.1002/ppul.24709] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 02/19/2020] [Indexed: 01/16/2023]
Abstract
BACKGROUND Quantifying the chest wall is useful in documenting thoracoabdominal synchrony during the neonatal period. Subjective measures are often used rather than gold-standard methods due to their practicality in clinical practice. The aim of the present study is to compare the reliability between a newly proposed method (video analysis in MATLAB) and image analysis using AutoCad tools, both applied to assess thoracoabdominal motion in newborns (NBs). MATERIALS AND METHODS This is an observational cross-sectional study of full-term NBs. A digital camera was used to film thoracoabdominal motion for 2 minutes in the supine position, with movements measured by the two aforementioned methodologies. RESULTS A total of 139 images were used, showing agreement between AutoCAD and MATLAB (BIAS = -1.68; CI = -6.59:3.22, Bland-Altman plot). CONCLUSION The programs were interchangeable and the routine developed in MATLAB was simpler and faster, allowing dynamic analysis and suggesting its clinical utility in quantifying respiratory motion in NBs.
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Affiliation(s)
- Danielle C Gomes
- Rehabilitation Sciences Graduate Program, Universidade Federal do Rio Grande do Norte, Santa Cruz, Rio Grande do Norte, Brazil
| | - Ingrid G Azevedo
- Kinesiología Course, Universidad Católica de Temuco, Temuco, Chile
| | - Ana G de Figueiredo Araújo
- Rehabilitation Sciences Graduate Program, Universidade Federal do Rio Grande do Norte, Santa Cruz, Rio Grande do Norte, Brazil
| | - Lenice D da Costa Lopes
- FACISA, Universidade Federal do Rio Grande do Norte, Santa Cruz, Rio Grande do Norte, Brazil
| | - Danilo A P Nagem
- Departamento de Engenharia Biomédica, Universidade Federal do Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - Fabrício A Magalhães
- Departamento de Fisioterapia, Graduate Program in Rehabilitation Sciences, Univerisdade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Silvana A Pereira
- Rehabilitation Sciences Graduate Program, Universidade Federal do Rio Grande do Norte, Santa Cruz, Rio Grande do Norte, Brazil.,Departamento de Fisioterapia, Universidade Federal do Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
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Chest wall volume and asynchrony in stroke and Parkinson's disease subjects: A case-control study. PLoS One 2019; 14:e0216641. [PMID: 31095580 PMCID: PMC6522099 DOI: 10.1371/journal.pone.0216641] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Accepted: 04/26/2019] [Indexed: 11/22/2022] Open
Abstract
Background The expansion of the rib cage and abdomen occurs in a synchronic way during a coordinated contraction of the diaphragm and the abdominal and intercostal muscles under normal conditions and healthy. The presence of restrictive respiratory disease may lead to uncoordinated action of the respiratory muscles which affects breathing pattern and chest wall volumes. The aim of this study was to evaluate chest wall volumes, chest wall asynchrony and inspiratory paradoxical movement of breathing, as well as the influence of the time of disease diagnosis in subjects with Parkinson’s disease and post-Stroke in comparison to healthy individuals. Methods Total and compartmental chest wall volumes, chest wall asynchrony and paradoxical movement were measured at rest in a seated position by Optoelectronic Plethysmography in 76 individuals (29 healthy individuals, 20 post-Stroke and 27 Parkinson’s disease subjects). Post-stroke and Parkinson’s disease subjects were also grouped according to the length of diagnosis. Results In both groups with restrictive respiratory disease we observed that pulmonary rib cage compartment (VRCp) volume is reduced when compared to healthy subjects (p <0.05). This same pattern was observed when analyzing post-stroke subjects with more than three years of diagnosis and Parkinson’s subjects with less than three years of diagnosis (p<0.05). Furthermore, post-stroke subjects with inspiratory paradoxical movement showed decreased total and compartmental chest wall volumes (p<0.05), while individuals with Parkinson’s disease with inspiratory paradoxical movement only presented a decrease in pulmonary rib cage compartment volume (p<0.05). Conclusion Our study presents new findings for better understanding of chest wall volumes and chest wall asynchrony in post-stroke and Parkinson’s disease individuals. Half of the subjects with post-Stroke and Parkinson’s disease presented inspiratory paradox movement, but changes in breathing pattern was especially observed in post-stroke subjects with more than three years of diagnosis.
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The Respiratory Fluctuation Index: A global metric of nasal airflow or thoracoabdominal wall movement time series to diagnose obstructive sleep apnea. Biomed Signal Process Control 2019. [DOI: 10.1016/j.bspc.2018.12.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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28
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Age-related ranges of respiratory inductance plethysmography (RIP) reference values for infants and children. Paediatr Respir Rev 2019; 29:60-67. [PMID: 30799137 DOI: 10.1016/j.prrv.2018.03.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Revised: 03/09/2018] [Accepted: 03/09/2018] [Indexed: 11/21/2022]
Abstract
The current noninvasive method for respiratory monitoring is respiratory inductance plethysmography (RIP); two bands are connected, one each to the chest and the abdomen, to measure the breathing pattern. RIP requires post hoc analysis to calculate indices such as respiratory rate, phase angle, labored breathing index, and percent of rib cage contribution to breathing. Clinical studies have provided patient RIP values and age-matched normal values, but they lack global evaluation of normative data for a wide age range of pediatric subjects. Herein, we compiled normative RIP indices from numerous studies for a large range of pediatric ages. From these data, we derived regression equations useful for computing normal RIP parameters as a function of age. The presented review will provide caregivers the ability to compare RIP data of pediatric patients against the regression analysis. This comparison will help identify patients with pulmonary complications and aid in guiding respiratory therapy.
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Strang A, Ryan L, Rahman T, Balasubramanian S, Hossain J, Heinle R, Shaffer TH. Measures of respiratory inductance plethysmography (RIP) in children with neuromuscular disease. Pediatr Pulmonol 2018; 53:1260-1268. [PMID: 29999598 DOI: 10.1002/ppul.24134] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 07/01/2018] [Indexed: 11/10/2022]
Abstract
BACKGROUND Pulmonary function testing (PFT) is essential for the clinical assessment of respiratory problems. Respiratory inductance plethysmography (RIP) is a non-invasive method of PFT requiring minimal patient cooperation. RIP measures the volumetric change in the ribcage and abdomen, from which work of breathing (WOB) indices are derived. WOB indices include: phase angle (Ф), percent ribcage (RC%), respiratory rate (RR), and labored breathing index (LBI). Heart rate (HR) is collected separately. AIM The goal of this study was to assess the utility of a newly developed RIP system, the pneuRIP, in an outpatient clinic setting in children with neuromuscular (NM) disease. METHOD The pneuRIP system measures and displays the WOB indices in real-time on an iPad display. Forty-three subjects, 22 NM patients and 21 healthy children (ages: 5-18 years) were enrolled. RESULTS Patients' means showed an increase of 119.8% for Ф, 15.7% for LBI, and 19.9% for HR compared with healthy subjects, when adjusted for age and gender. The study found significant differences between the mean values of the healthy subjects and patients in Ф (P = 0.000), LBI (P = 0.001), and HR (P = 0.001). No differences were noted for RC% and RR between groups. Data for Ф in NM patients were diffusely distributed as compared with healthy subjects based on analysis of histograms. CONCLUSION Non-invasive pneuRIP testing provided instantaneous PFT results. As compared to healthy subjects, NM patients showed abnormal results with increased markers of thoracoabdominal asynchrony, WOB indices, and biphasic breathing patterns likely resulting from NM weakness.
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Affiliation(s)
- Abigail Strang
- Department of Biomedical Research and Center for Pediatric Lung Research, Nemours/Alfred I. duPont Hospital for Children, Wilmington, Delaware
| | - Lauren Ryan
- Department of Biomedical Research and Center for Pediatric Lung Research, Nemours/Alfred I. duPont Hospital for Children, Wilmington, Delaware
| | - Tariq Rahman
- Department of Biomedical Research and Center for Pediatric Lung Research, Nemours/Alfred I. duPont Hospital for Children, Wilmington, Delaware
| | - Sona Balasubramanian
- Department of Biomedical Research and Center for Pediatric Lung Research, Nemours/Alfred I. duPont Hospital for Children, Wilmington, Delaware
| | - Jobayer Hossain
- Department of Biomedical Research and Center for Pediatric Lung Research, Nemours/Alfred I. duPont Hospital for Children, Wilmington, Delaware
| | - Robert Heinle
- Department of Biomedical Research and Center for Pediatric Lung Research, Nemours/Alfred I. duPont Hospital for Children, Wilmington, Delaware
| | - Thomas H Shaffer
- Department of Biomedical Research and Center for Pediatric Lung Research, Nemours/Alfred I. duPont Hospital for Children, Wilmington, Delaware
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Bronstein JZ, Xie L, Shaffer TH, Chidekel A, Heinle R. Quantitative Analysis of Thoracoabdominal Asynchrony in Pediatric Polysomnography. J Clin Sleep Med 2018; 14:1169-1176. [PMID: 29991414 DOI: 10.5664/jcsm.7218] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Accepted: 04/05/2018] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Objective measurements of thoracoabdominal asynchrony (TAA), such as average phase angle (θavg), can quantify airway obstruction. This study demonstrates and evaluates use of θavg for predicting obstructive sleep apnea (OSA) in pediatric polysomnography (PSG). METHODS This prospective observational study recruited otherwise healthy 3- to 8-year-old children presenting for PSG due to snoring, behavioral problems, difficulty sleeping, and/or enlarged tonsils. Respiratory inductance plethysmography (RIP) was directly monitored and data were collected during each PSG. θavg and average labored breathing index (LBIavg) were calculated for earliest acceptable 5-minute periods of stage N3 sleep and stage R sleep. Associations between θavg and obstructive apnea index (OAI) and obstructive apnea-hypopnea index (OAHI), as well as between LBIavg and OAI and OAHI, were examined. RESULTS Forty patients undergoing PSG were analyzed. Thirty percent of patients had OSA, 57.5% had enlarged tonsils, and 17.5% were obese. θavg during stage N3 sleep and stage R sleep had significant positive correlations with OAI (Spearman r = .35 [P = .03] and .40 [P = .01], respectively) and θavg during stage N3 sleep with OAHI (r = .35 [P = .03]). LBIavg showed lower correlations. Median θavg during stage R sleep (33.1) was significantly greater than during stage N3 sleep (13.7, P = .0005). CONCLUSIONS Association of θavg with OAI and OAHI shows that θavg reflects airway obstruction and has potential use as a quantitative indicator of OSA. RIP provides valuable information that is readily available in PSG. The significant difference between θavg in stage N3 sleep and stage R sleep confirms the clinical observation that there is more asynchrony during rapid eye movement sleep than non-rapid eye movement sleep.
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Affiliation(s)
- Jason Z Bronstein
- Division of Pulmonology, Nemours/Alfred I. duPont Hospital for Children, Wilmington, Delaware
| | - Li Xie
- Biostatistics Core, Nemours Biomedical Research, Nemours/Alfred I. duPont Hospital for Children, Wilmington, Delaware
| | - Thomas H Shaffer
- Center for Pediatric Lung Research, Nemours/Alfred I. duPont Hospital for Children, Wilmington, Delaware
| | - Aaron Chidekel
- Division of Pulmonology, Nemours/Alfred I. duPont Hospital for Children, Wilmington, Delaware
| | - Robert Heinle
- Division of Pulmonology, Nemours/Alfred I. duPont Hospital for Children, Wilmington, Delaware
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Sarmento A, Fregonezi G, Dourado-Junior MET, Aliverti A, de Andrade AD, Parreira VF, Resqueti V. Thoracoabdominal asynchrony and paradoxical motion in middle stage amyotrophic lateral sclerosis. Respir Physiol Neurobiol 2018; 259:16-25. [PMID: 29969705 DOI: 10.1016/j.resp.2018.06.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 06/19/2018] [Accepted: 06/24/2018] [Indexed: 11/26/2022]
Abstract
AIM To assess thoracoabdominal asynchrony (TAA) and the presence of paradoxical motion in middle stage amyotrophic lateral sclerosis (ALS) and its relationships with chest wall tidal volume (VT,CW), breathing pattern and cough peak flow (CPF). METHODS Phase angle (θ) between upper (RCp) and lower ribcage (RCa) and abdomen (AB), as well as percentage of inspiratory time for the lower ribcage (IPRCa) and abdomen (IPAB) moving in opposite directions were quantified using optoelectronic plethysmography in 12 ALS patients during quiet breathing and coughing. Paradoxical motion of the compartments was based on threshold values of θ and IP, obtained in twelve age and sex matched healthy persons. RESULTS During quiet breathing, significantly higher RCa and AB θ (p < .05), IPRCa (p = 0.001) and IPAB (p < 0.05) were observed in ALS patients as compared to controls. In ALS patients, correlations between RCa and AB θ with forced vital capacity (FVC) (r=-0.773, p < 0.01), vital capacity (r=-0.663, p < 0.05) and inspiratory capacity (IC) (r=-0.754, p < 0.01), as well as between RCp and RCa θ with FVC (r=-0.608, p < 0.05) and CPF (r=-0.601, p < 0.05) were found. During coughing, correlations between RCp and AB θ with CPF (r=-0.590, p < 0.05), IC (r=-0.748, p < 0.01) and VT,CW (r=-0.608, p < 0.05), as well as between RCa and AB θ with CPF (r=-0.670, p < 0.05), IC (r=-0.713, p < 0.05) and peak expiratory flow (r=-0.727, p < 0.05) were also observed in ALS patients. ALS patients with paradoxical motion presented lower vital capacity and FVC%pred (p < 0.05) compared to those without paradoxical motion. CONCLUSIONS Middle stage ALS patients exhibit TAA and paradoxical motion during quiet spontaneous breathing and coughing. In addition, diaphragmatic weakness (i.e. decrease in excursion of the RCa and AB compartments) was observed earlier in the lower ribcage rather than the abdominal compartment in this population.
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Affiliation(s)
- Antonio Sarmento
- PneumoCardioVascular Lab, Hospital Universitário Onofre Lopes, Empresa Brasileira de Serviços Hospitalares (EBSERH), Universidade Federal do Rio Grande do Norte, Brazil
| | - Guilherme Fregonezi
- PneumoCardioVascular Lab, Hospital Universitário Onofre Lopes, Empresa Brasileira de Serviços Hospitalares (EBSERH), Universidade Federal do Rio Grande do Norte, Brazil
| | | | - Andrea Aliverti
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Italy
| | | | | | - Vanessa Resqueti
- PneumoCardioVascular Lab, Hospital Universitário Onofre Lopes, Empresa Brasileira de Serviços Hospitalares (EBSERH), Universidade Federal do Rio Grande do Norte, Brazil.
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Zaffanello M, Lippi G, Tenero L, Piazza M, Sacchetto L, Nosetti L, Gasperi E, Piacentini G. Childhood nasal obstruction and sleep-disordered breathing during clinical setting: Myth or reality? ACTA ACUST UNITED AC 2018. [DOI: 10.18621/eurj.410657] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Chen YC, Hsiao TC. Towards estimation of respiratory muscle effort with respiratory inductance plethysmography signals and complementary ensemble empirical mode decomposition. Med Biol Eng Comput 2017; 56:1293-1303. [PMID: 29280093 DOI: 10.1007/s11517-017-1766-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Accepted: 12/13/2017] [Indexed: 12/01/2022]
Abstract
Respiratory inductance plethysmography (RIP) sensor is an inexpensive, non-invasive, easy-to-use transducer for collecting respiratory movement data. Studies have reported that the RIP signal's amplitude and frequency can be used to discriminate respiratory diseases. However, with the conventional approach of RIP data analysis, respiratory muscle effort cannot be estimated. In this paper, the estimation of the respiratory muscle effort through RIP signal was proposed. A complementary ensemble empirical mode decomposition method was used, to extract hidden signals from the RIP signals based on the frequency bands of the activities of different respiratory muscles. To validate the proposed method, an experiment to collect subjects' RIP signal under thoracic breathing (TB) and abdominal breathing (AB) was conducted. The experimental results for both the TB and AB indicate that the proposed method can be used to loosely estimate the activities of thoracic muscles, abdominal muscles, and diaphragm. Graphical abstract ᅟ.
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Affiliation(s)
- Ya-Chen Chen
- Institute of Computer Science and Engineering, National Chiao Tung University, Hsinchu, Taiwan, Republic of China
| | - Tzu-Chien Hsiao
- Institute of Biomedical Engineering, National Chiao Tung University, Hsinchu, Taiwan, Republic of China. .,Department of Computer Science, National Chiao Tung University, Hsinchu, Taiwan, Republic of China. .,Biomedical Electronics Translational Research Center and Biomimetic Systems Research Center, National Chiao Tung University, Hsinchu, Taiwan, Republic of China.
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Pereira MC, Porras DC, Lunardi AC, da Silva CCBM, Barbosa RCC, Cardenas LZ, Pletsch R, Ferreira JG, de Castro I, de Carvalho CRF, Caruso P, de Carvalho CRR, de Albuquerque ALP. Thoracoabdominal asynchrony: Two methods in healthy, COPD, and interstitial lung disease patients. PLoS One 2017; 12:e0182417. [PMID: 28767680 PMCID: PMC5540557 DOI: 10.1371/journal.pone.0182417] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Accepted: 07/18/2017] [Indexed: 11/18/2022] Open
Abstract
Background Thoracoabdominal asynchrony is the nonparallel motion of the ribcage and abdomen. It is estimated by using respiratory inductive plethysmography and, recently, using optoelectronic plethysmography; however the agreement of measurements between these 2 techniques is unknown. Therefore, the present study compared respiratory inductive plethysmography with optoelectronic plethysmography for measuring thoracoabdominal asynchrony to see if the measurements were similar or different. Methods 27 individuals (9 healthy subjects, 9 patients with interstitial lung disease, and 9 with chronic obstructive pulmonary disease performed 2 cycle ergometer tests with respiratory inductive plethysmography or optoelectronic plethysmography in a random order. Thoracoabdominal asynchrony was evaluated at rest, and at 50% and 75% of maximal workload between the superior ribcage and abdomen using a phase angle. Results Thoracoabdominal asynchrony values were very similar in both approaches not only at rest but also with exercise, with no statistical difference. There was a good correlation between the methods and the Phase angle values were within the limits of agreement in the Bland-Altman analysis. Conclusion Thoracoabdominal asynchrony measured by optoelectronic plethysmography and respiratory inductive plethysmography results in similar values and has a satisfactory agreement at rest and even for different exercise intensities in these groups.
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Affiliation(s)
- Mayra Caleffi Pereira
- Pulmonary Division, Heart Institute (Incor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
- Sírio-Libanês Teaching and Research Institute, São Paulo, Brazil
| | - Desiderio Cano Porras
- Department of Physical Therapy, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Adriana Claudia Lunardi
- Department of Physical Therapy, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | | | - Renata Cléia Claudino Barbosa
- Department of Physical Therapy, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Letícia Zumpano Cardenas
- Pulmonary Division, Heart Institute (Incor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Renata Pletsch
- Pulmonary Division, Heart Institute (Incor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Jeferson George Ferreira
- Pulmonary Division, Heart Institute (Incor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Isac de Castro
- Sírio-Libanês Teaching and Research Institute, São Paulo, Brazil
| | | | - Pedro Caruso
- Pulmonary Division, Heart Institute (Incor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Carlos Roberto Ribeiro de Carvalho
- Pulmonary Division, Heart Institute (Incor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - André Luis Pereira de Albuquerque
- Pulmonary Division, Heart Institute (Incor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
- Sírio-Libanês Teaching and Research Institute, São Paulo, Brazil
- * E-mail:
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Intra-rater and inter-rater reliability of total faulty breathing scale using visual observation and videogrammetry methods. J Bodyw Mov Ther 2017; 21:694-698. [DOI: 10.1016/j.jbmt.2016.10.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2016] [Revised: 08/08/2016] [Accepted: 10/20/2016] [Indexed: 11/17/2022]
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Cano Porras D, Lunardi AC, Marques da Silva CCB, Paisani DM, Stelmach R, Moriya HT, Carvalho CRF. Comparison between the phase angle and phase shift parameters to assess thoracoabdominal asynchrony in COPD patients. J Appl Physiol (1985) 2017; 122:1106-1113. [DOI: 10.1152/japplphysiol.00508.2016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Revised: 02/03/2017] [Accepted: 02/03/2017] [Indexed: 11/22/2022] Open
Abstract
Determining the presence of thoracoabdominal asynchrony in chronic obstructive pulmonary disease (COPD) patients is clinically relevant, but there is no consensus on the optimal parameters for performing this analysis. We assessed 22 COPD patients (FEV1 40 ± 10% predicted) and 13 healthy controls during rest and exercise with optoelectronic plethysmography (70% maximum workload) on a cycle ergometer. Thoracoabdominal asynchrony was calculated by using phase angle and phase shift parameters following a three-compartment model involving the upper and lower rib cages and abdomen. Patients were classified as having thoracoabdominal asynchrony (TAA+) or not (TAA−) based on control values (mean ± 2 SDs). The chest wall volume and compartmental contribution were also measured. Thoracoabdominal asynchrony was observed in the lower rib cage. The phase angle detected more TAA+ patients at rest (15 vs. 7 patients) and during exercise (14 vs. 8 patients) compared with the phase shift. TAA+ patients also presented a lower chest wall volume, lower rib cage contribution, and higher abdominal contribution to chest wall volume compared with the control and TAA− patients. Thoracoabdominal asynchrony was more detectable during rest and exercise using the phase angle parameter, and it was observed in the lower rib cage compartment, reducing the chest wall volume during exercise in patients with COPD. NEW & NOTEWORTHY This study contributes to advance the knowledge over the previous lack of consensus on the assessment of thoracoabdominal asynchrony. We rigorously evaluated the related features that interfere in the measurement of the asynchrony (measurement tool, chest wall model and calculation parameter). Our results suggest that phase angle detects more suitably thoracoabdominal asynchrony that occurs on the lower ribcage and leads to a reduction in the chest wall volume during exercise in COPD patients.
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Affiliation(s)
- Desiderio Cano Porras
- Department of Physical Therapy, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Adriana C. Lunardi
- Department of Physical Therapy, School of Medicine, University of São Paulo, São Paulo, Brazil
| | | | - Denise M. Paisani
- Department of Physical Therapy, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Rafael Stelmach
- Pulmonary Division, Heart Institute (InCor), School of Medicine, University of São Paulo, São Paulo, Brazil; and
| | - Henrique T. Moriya
- Biomedical Engineering Laboratory, Department of Telecommunication and Control Engineering, School of Engineering, University of São Paulo, São Paulo, Brazil
| | - Celso R. F. Carvalho
- Department of Physical Therapy, School of Medicine, University of São Paulo, São Paulo, Brazil
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Chen YC, Hsiao TC. Instantaneous phase difference analysis between thoracic and abdominal movement signals based on complementary ensemble empirical mode decomposition. Biomed Eng Online 2016; 15:112. [PMID: 27716248 PMCID: PMC5053353 DOI: 10.1186/s12938-016-0233-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Accepted: 09/28/2016] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Thoracoabdominal asynchrony is often adopted to discriminate respiratory diseases in clinics. Conventionally, Lissajous figure analysis is the most frequently used estimation of the phase difference in thoracoabdominal asynchrony. However, the temporal resolution of the produced results is low and the estimation error increases when the signals are not sinusoidal. Other previous studies have reported time-domain procedures with the use of band-pass filters for phase-angle estimation. Nevertheless, the band-pass filters need calibration for phase delay elimination. METHODS To improve the estimation, we propose a novel method (named as instantaneous phase difference) that is based on complementary ensemble empirical mode decomposition for estimating the instantaneous phase relation between measured thoracic wall movement and abdominal wall movement. To validate the proposed method, experiments on simulated time series and human-subject respiratory data with two breathing types (i.e., thoracic breathing and abdominal breathing) were conducted. Latest version of Lissajous figure analysis and automatic phase estimation procedure were compared. RESULTS The simulation results show that the standard deviations of the proposed method were lower than those of two other conventional methods. The proposed method performed more accurately than the two conventional methods. For the human-subject respiratory data, the results of the proposed method are in line with those in the literature, and the correlation analysis result reveals that they were positively correlated with the results generated by the two conventional methods. Furthermore, the standard deviation of the proposed method was also the smallest. CONCLUSIONS To summarize, this study proposes a novel method for estimating instantaneous phase differences. According to the findings from both the simulation and human-subject data, our approach was demonstrated to be effective. The method offers the following advantages: (1) improves the temporal resolution, (2) does not introduce a phase delay, (3) works with non-sinusoidal signals, (4) provides quantitative phase estimation without estimating the embedded frequency of breathing signals, and (5) works without calibrated measurements. The results demonstrate a higher temporal resolution of the phase difference estimation for the evaluation of thoracoabdominal asynchrony.
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Affiliation(s)
- Ya-Chen Chen
- Institute of Computer Science and Engineering, National Chiao Tung University, Hsinchu, 30010 Taiwan
| | - Tzu-Chien Hsiao
- Department of Computer Science, National Chiao Tung University, Hsinchu, 30010 Taiwan
- Institute of Biomedical Engineering, National Chiao Tung University, Hsinchu, 30010 Taiwan
- Biomedical Electronics Translational Research Center and Biomimetic Systems Research Center, National Chiao Tung University, Hsinchu, 30010 Taiwan
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Seppanen TM, Kananen J, Alho OP, Seppanen T. Accurate measurement of respiratory airflow waveforms using depth data. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2016; 2015:7857-60. [PMID: 26738113 DOI: 10.1109/embc.2015.7320213] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Respiratory disorders are a very common and growing health problem. Signal waveforms of respiratory airflow and volume may indicate pathological signs of several diseases and, thus, it would be important to measure them accurately. Currently, devices used in respiration measurements are mostly obtrusive in nature interfering with the natural respiration patterns. We used a depth camera for the continuous measurement of respiratory function without contact on a subject. We propose a novel calibration method which enables accurate estimates of the respiratory airflow waveforms from the depth camera data. Eight subjects were measured with the depth camera and spirometer at the same time using different breathing styles. Results show that not only the respiratory volume and respiratory rate (RR) can be computed precisely from the estimated respiratory airflow, but also the respiratory airflow waveforms are very accurate. This offers interesting opportunities, e.g. in pulmonary and critical care medicine, when objective measurements are required.
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Boulding R, Stacey R, Niven R, Fowler SJ. Dysfunctional breathing: a review of the literature and proposal for classification. Eur Respir Rev 2016; 25:287-94. [DOI: 10.1183/16000617.0088-2015] [Citation(s) in RCA: 132] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Accepted: 03/17/2016] [Indexed: 11/05/2022] Open
Abstract
Dysfunctional breathing is a term describing breathing disorders where chronic changes in breathing pattern result in dyspnoea and other symptoms in the absence or in excess of the magnitude of physiological respiratory or cardiac disease. We reviewed the literature and propose a classification system for the common dysfunctional breathing patterns described. The literature was searched using the terms: dysfunctional breathing, hyperventilation, Nijmegen questionnaire and thoraco-abdominal asynchrony. We have summarised the presentation, assessment and treatment of dysfunctional breathing, and propose that the following system be used for classification. 1) Hyperventilation syndrome: associated with symptoms both related to respiratory alkalosis and independent of hypocapnia. 2) Periodic deep sighing: frequent sighing with an irregular breathing pattern. 3) Thoracic dominant breathing: can often manifest in somatic disease, if occurring without disease it may be considered dysfunctional and results in dyspnoea. 4) Forced abdominal expiration: these patients utilise inappropriate and excessive abdominal muscle contraction to aid expiration. 5) Thoraco-abdominal asynchrony: where there is delay between rib cage and abdominal contraction resulting in ineffective breathing mechanics.This review highlights the common abnormalities, current diagnostic methods and therapeutic implications in dysfunctional breathing. Future work should aim to further investigate the prevalence, clinical associations and treatment of these presentations.
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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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Estrada L, Torres A, Sarlabous L, Fiz JA, Gea J, Martinez-Llorens J, Jane R. Estimation of bilateral asynchrony between diaphragm mechanomyographic signals in patients with chronic obstructive pulmonary disease. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2015; 2014:3813-6. [PMID: 25570822 DOI: 10.1109/embc.2014.6944454] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The aim of the present study was to measure bilateral asynchrony in patients suffering from Chronic Obstructive Pulmonary Disease (COPD) performing an incremental inspiratory load protocol. Bilateral asynchrony was estimated by the comparison of respiratory movements derived from diaphragm mechanomyographic (MMGdi) signals, acquired by means of capacitive accelerometers placed on left and right sides of the rib cage. Three methods were considered for asynchrony evaluation: Lissajous figure, Hilbert transform and Motto's algorithm. Bilateral asynchrony showed an increase at 20, 40 and 60% (values of normalized inspiratory pressure by their maximum value reached in the last inspiratory load) while the very severe group showed an increase at 20, 40, 80, and 100 % during the protocol. These increments in the phase's shift can be due to an increase of the inspiratory load along the protocol, and also as a consequence of distress and fatigue. In summary, this work evidenced the capability to estimate bilateral asynchrony in COPD patients. These preliminary results also showed that the use of capacitive accelerometers can be a suitable sensor for recording of respiratory movement and evaluation of asynchrony in COPD patients.
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Miller KM, Kim AY, Yaster M, Kudchadkar SR, White E, Fackler J, Monitto CL. Long-term tolerability of capnography and respiratory inductance plethysmography for respiratory monitoring in pediatric patients treated with patient-controlled analgesia. Paediatr Anaesth 2015; 25:1054-9. [PMID: 26040512 PMCID: PMC5080840 DOI: 10.1111/pan.12702] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/07/2015] [Indexed: 12/30/2022]
Abstract
BACKGROUND The Anesthesia Patient Safety Foundation has advocated the use of continuous electronic monitoring of oxygenation and ventilation to preemptively identify opioid-induced respiratory depression. In adults, capnography is the gold standard in respiratory monitoring. An alternative technique used in sleep laboratories is respiratory inductance plethysmography (RIP). However, it is not known if either monitor is well tolerated by pediatric patients for prolonged periods of time. AIM The goal of this study was to determine whether capnography or RIP is better tolerated in nonintubated, spontaneously breathing pediatric patients being treated with intravenous patient-controlled analgesia (IVPCA). METHODS Nasal cannula capnography with oral sampling and thoracic and abdominal inductance plethysmography bands were placed along with the routine monitors on pediatric patients being treated for acute pain with IVPCA. Study monitors were left in place for as long as they were tolerated by the patient, up to a maximum of 24 consecutive hours. If the patient did not wear a particular study monitor for any reason, but tolerated the remaining monitor, participation in the study continued. If the patient would not wear either monitor, participation was terminated. RESULTS Twenty-six patients (18 female, eight male, average age 10.1 ± 5.5 years) consented to participate, but only 14 patients attempted to wear one or both the devices. Among those who wore either device, median time to device removal was 8.33 h (range 0.3-23.6 h) for capnography and 23.5 h (range 0.7-24 h) for RIP bands. CONCLUSION Children did not tolerate wearing capnography cannulae for prolonged periods of time, limiting the usefulness of this device as a continuous monitor of ventilation in children. RIP bands were better tolerated; however, they require further assessment of their utility. Until more effective, child-friendly monitors are developed and their utility is validated, guidelines recommended for adult patients cannot be extended to children.
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Affiliation(s)
- Karen M. Miller
- Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins School of Medicine, Baltimore, USA
| | - Andrew Y. Kim
- Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins School of Medicine, Baltimore, USA
| | - Myron Yaster
- Departments of Anesthesiology and Critical Care Medicine and Pediatrics, The Johns Hopkins School of Medicine, Baltimore, USA
| | - Sapna R. Kudchadkar
- Departments of Anesthesiology and Critical Care Medicine and Pediatrics, The Johns Hopkins School of Medicine, Baltimore, USA
| | - Elizabeth White
- Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins School of Medicine, Baltimore, USA
| | - James Fackler
- Departments of Anesthesiology and Critical Care Medicine and Pediatrics, The Johns Hopkins School of Medicine, Baltimore, USA
| | - Constance L. Monitto
- Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins School of Medicine, Baltimore, USA
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Mechanisms of cough provocation and cough resolution in neonates with bronchopulmonary dysplasia. Pediatr Res 2015; 78:462-9. [PMID: 26151491 PMCID: PMC4800483 DOI: 10.1038/pr.2015.131] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Accepted: 04/17/2015] [Indexed: 11/08/2022]
Abstract
BACKGROUND Cough and deglutition are protective mechanisms that defend against aspiration. We identified mechanisms associated with cough provocation as well as those associated with cough resolution in infants with bronchopulmonary dysplasia (BPD). METHODS Manometry signatures of cough were recognized in 16 premature infants with BPD undergoing concurrent esophageal manometry, respiratory inductance plethysmography, and nasal air flow measurements. Pretussive and post-tussive pharyngo-esophageal motility changes were analyzed. Mechanisms associated with cough and mechanisms that restored respiratory and esophageal normalcy were analyzed. RESULTS We analyzed 312 cough events during 88 cough clusters; 97% were associated with recognizable manometric patterns. Initial mechanisms related with coughing included nonpropagating swallow (59%), upper esophageal sphincter (UES) reflex contraction (18%), and lower esophageal sphincter (LES) relaxation (14%). UES and LES dysfunction was present in 69% of nonpropagating swallow-associated cough clusters. Mechanisms restoring post-tussive normalcy included primary peristalsis (84%), secondary peristalsis (8%), and none recognized (8%). UES contraction reflex was associated with cough clusters more frequently in infants on nasal continuous positive airway pressure (NCPAP) (OR = 9.13, 95% CI = 1.88-44.24). CONCLUSION Cough clusters in infants with BPD had identifiable etiologies associated with esophageal events; common initial mechanisms were of upper aerodigestive origin, while common clearing mechanisms were peristaltic reflexes.
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Kagawa M, Tojima H, Matsui T. Non-contact diagnostic system for sleep apnea–hypopnea syndrome based on amplitude and phase analysis of thoracic and abdominal Doppler radars. Med Biol Eng Comput 2015; 54:789-98. [DOI: 10.1007/s11517-015-1370-z] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Accepted: 08/07/2015] [Indexed: 12/01/2022]
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Real-time detection, classification, and quantification of apneic episodes using miniature surface motion sensors in rats. Pediatr Res 2015; 78:63-70. [PMID: 25826120 DOI: 10.1038/pr.2015.69] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2014] [Accepted: 01/13/2015] [Indexed: 11/09/2022]
Abstract
BACKGROUND Real-time detection and classification of apneic episodes remain significant challenges. This study explores the applicability of a novel method of monitoring the respiratory effort and dynamics for rapid detection and classification of apneic episodes. METHODS Obstructive apnea (OA) and hypopnea/central apnea (CA) were induced in nine tracheostomized rats, by short-lived airway obstruction and administration of succinylcholine, respectively. Esophageal pressure (EP), EtCO2, arterial O2 saturation (SpO2), heart rate, and blood pressure were monitored. Respiratory dynamics were monitored utilizing three miniature motion sensors placed on the chest and epigastrium. Three indices were derived from these sensors: amplitude of the tidal chest wall displacement (TDi), breath time length (BTL), that included inspiration and rapid expiration phases, and amplitude time integral (ATI), the integral of breath amplitude over time. RESULTS OA induced a progressive 6.42 ± 3.48-fold increase in EP from baseline, which paralleled a 3.04 ± 1.19-fold increase in TDi (P < 0.0012), a 1.39 ± 0.22-fold increase in BTL (P < 0.0002), and a 3.32 ± 1.40-fold rise in the ATI (P < 0.024). During central hypopneic/apneic episodes, each sensor revealed a gradual decrease in TDi, which culminated in absence of breathing attempts. CONCLUSION Noninvasive monitoring of chest wall dynamics enables detection and classification of central and obstructive apneic episodes, which tightly correlates with the EP.
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Silva L, Barcelar JDM, Rattes CS, Sayão LB, Reinaux CA, Campos SL, Brandão DC, Fregonezi G, Aliverti A, Dornelas de Andrade A. The influence of supine posture on chest wall volume changes is higher in obese than in normal weight children. Appl Physiol Nutr Metab 2015; 40:178-183. [PMID: 25641171 DOI: 10.1139/apnm-2014-0201] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2023]
Abstract
The objective of this study was to analyze thoraco-abdominal kinematics in obese children in seated and supine positions during spontaneous quiet breathing. An observational study of pulmonary function and chest wall volume assessed by optoelectronic plethysmography was conducted on 35 children aged 8-12 years that were divided into 2 groups according to weight/height ratio percentiles: there were 18 obese children with percentiles greater than 95 and 17 normal weight children with percentiles of 5-85. Pulmonary function (forced expiratory volume in 1 s (FEV1); forced vital capacity (FVC); and FEV1/FVC ratio), ventilatory pattern, total and compartment chest wall volume variations, and thoraco-abdominal asynchronies were evaluated. Tidal volume was greater in seated position. Pulmonary and abdominal rib cage tidal volume and their percentage contribution to tidal volume were smaller in supine position in both obese and control children, while abdominal tidal volume and its percentage contribution was greater in the supine position only in obese children and not in controls. No statistically significant differences were found between obese and control children and between supine and seated positions regarding thoraco-abdominal asynchronies. We conclude that in obese children thoraco-abdominal kinematics is influenced by supine posture, with an increase of the abdominal and a decreased rib cage contribution to ventilation, suggesting that in this posture areas of hypoventilation can occur in the lung.
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Affiliation(s)
- Letícia Silva
- a Departamento de Fisioterapia da Universidade Federal do Rio Grande do Norte, Natal, Rio Grande do Norte, Brasil
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Abstract
Tests of pulmonary function are useful tools for evaluating the potential for compounds to produce toxicity affecting the pulmonary system. Insults to the pulmonary system (i.e., due to drugs, biologics, toxins) can cause detectable dysfunction through multiple mechanisms. Manifestation of the response to insults will depend on the component(s) involved and the compensatory mechanism(s) initiated. The purpose of this chapter is to introduce the concepts of pulmonary testing as it is applied to the preclinical evaluation of pharmaceutical test articles. The topics will include the techniques and methods that have been developed for use in nonclinical (animal) subjects and the parameters that are routinely measured.
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Affiliation(s)
- Michael Stonerook
- Independent Toxicology/Safety Pharmacology Consultant, Columbia, MO, USA,
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Jassar RK, Vellanki H, Zhu Y, Hesek AM, Wang J, Rodriguez E, Wolfson MR, Shaffer TH. High flow nasal heliox improves work of breathing and attenuates lung injury in a newborn porcine lung injury model. J Neonatal Perinatal Med 2015; 8:323-331. [PMID: 26757007 DOI: 10.3233/npm-15915039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
BACKGROUND High flow nasal cannula (HFNC) has been shown to improve ventilation and oxygenation and reduce work of breathing in newborns with respiratory distress. Heliox, decreases resistance to airflow, reduces the work of breathing, facilitates the distribution of inspired gas, and has been shown to attenuate lung inflammation during the treatment of acute lung injury. HYPOTHESIS Heliox delivered by HFNC will decrease resistive load, decrease work of breathing, improve ventilation and attenuate lung inflammation during spontaneous breathing following acute lung injury in the newborn pig. METHODS Spontaneously breathing neonatal pigs received Nitrox or Heliox by HFNC and studied over 4 hrs following oleic acid injury. Gas exchange, pulmonary mechanics and systemic inflammation were measured serially. Lung inflammation biomarkers were assessed at termination. RESULTS Heliox breathing animals demonstrated lower work of breathing reflected by lower tracheal pressure, phase angle and phase relationship. Ventilation efficiency index was greater compared to Nitrox. Heliox group showed less lung inflammation reflected by lower tissue interleukin-6 and 8. CONCLUSION High flow nasal Heliox decreased respiratory load, reduced resistive work of breathing indices and attenuated lung inflammatory profile while ventilation was supported at less pressure effort in the presence of acute lung injury.
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Affiliation(s)
- R K Jassar
- Neonatology, Alfred I. duPont Hospital for Children, Wilmington, DE, USA
- Neonatology, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - H Vellanki
- Neonatology, Alfred I. duPont Hospital for Children, Wilmington, DE, USA
- Neonatology, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Yan Zhu
- Alfred I. duPont Hospital for Children, Center for Pediatric Lung Research, Wilmington, DE, USA
| | - A M Hesek
- Alfred I. duPont Hospital for Children, Center for Pediatric Lung Research, Wilmington, DE, USA
| | - J Wang
- Alfred I. duPont Hospital for Children, Center for Pediatric Lung Research, Wilmington, DE, USA
| | - E Rodriguez
- Alfred I. duPont Hospital for Children, Center for Pediatric Lung Research, Wilmington, DE, USA
- Nemours Biomedical Research, Alfred I. duPont Hospital for Children, Wilmington, DE, USA
| | - M R Wolfson
- Temple University School of Medicine, Departments of Physiology, Pediatrics, and Medicine, Center for Inflammation, Translational and Clinical Lung Research, Philadelphia, PA, USA
| | - T H Shaffer
- Alfred I. duPont Hospital for Children, Center for Pediatric Lung Research, Wilmington, DE, USA
- Temple University School of Medicine, Department of Physiology and Pediatrics, Philadelphia, PA, USA
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Cavalcanti AGL, Lima CSFR, de Sá RB, Reinaux CMA, Braz Júnior DS, Teixeira ALS, de Andrade AD, Marinho PEM. Influence of posture on the ventilatory pattern and the thoraco-abdominal kinematics of patients with chronic obstructive pulmonary disease (COPD). Physiother Theory Pract 2014; 30:490-4. [PMID: 24678754 DOI: 10.3109/09593985.2014.901458] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Evaluate the influence of posture on ventilatory pattern, compartmental distribution of volume of chest wall and thoraco-abdominal kinematics of patients with severe chronic obstructive pulmonary disease (COPD). DESIGN Cross-sectional study. METHODS Twelve, male patients with severe COPD (Forced Expiratory Volume in the first second (FEV1) = 24.35 ± 4.52%, Forced Vital Capacity% (FVC%) = 60 ± 13.39% and relationship FEV1/FVC = 53.42 ± 14.47). The distribution of the volume of the ribcage [pulmonary rib cage (Rcp), abdominal ribcage (Rca) and abdomen (Ab)] during quiet breathing in a sitting position without back support (SWB), sitting with backrest (SB) and supine position (SUP) was determined using an opto-electronic plethysmograph. RESULTS The following differences were observed: a greater tidal volume in the SWB position when compared to the SB position (p = 0.01); greater expiratory time in the SUP position in relation to the SWB (p = 0.03) and SB (p = 0.01); and increased abdominal contribution to the tidal volume in the SUP position in relation to the SWB (p < 0.01) and SB (p < 0.001). No difference was found in the thoraco-abdominal synchrony among the positions. CONCLUSION Sitting position without back support enhances the activation of respiratory muscles by increasing the tidal volume and supine position seems to favor lung deflation by increasing the expiratory time. It seems appropriate to adopt these positions to optimize the ventilation/perfusion relationship and physiotherapeutic intervention in different clinical conditions.
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Affiliation(s)
- Ana Gabriela L Cavalcanti
- Department of Physical Therapy, Cardiorespiratory Physical Therapy Laboratory , Federal University of Pernambuco, Av. Jornalista Anibal Fernandes, s/n, Cidade Universitária, Recife , Brazil
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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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