Machine learning for automatic identification of thoracoabdominal asynchrony in children

Utilising pneuRIP device in determining the adequacy of respiratory support when weaning high-flow nasal cannula in paediatric patients with acute respiratory distress: A pilot study

AIM

Recognition of paediatric respiratory distress and timely intervention is critical, especially during the weaning phase of support in paediatric acute respiratory failure, as weaning too aggressively can lead to further setbacks in a patient's recovery. We aimed to determine if pulmonary function measurements obtained with the pneuRIP device, a noninvasive pulmonary function testing device that provides measurements of labored breathing index (LBI), phase angle and %rib cage (%RC) contribution to breathing, will provide predictive values to assess the adequacy of respiratory support while weaning from HFNC.

METHODS

We reviewed patients ages 0-18 years admitted to the PICU for respiratory distress due to respiratory infections receiving HFNC. Patients with history of chronic lung disease and chronic neuromuscular disease with baseline habnormal breathing patterns were excluded. Phase angle, LBI and %RC were obtained every hour and with every wean of HFNC. Nine patients were enroled.

RESULTS

Mean LBI range remained 1.27-1.68 when LBI was plotted as a function of the HFNC flow rate. Mean values of %RC contribution to breathing ranged 43.65-57.12 as a function of the HFNC flow rate. No significant deviations existed in either %RC (P = 0.16) or LBI (P = 0.16) during the weaning of HFNC. Mean phase angle for all subjects was 41.48°-74.12° for the duration of wean and showed significant deviation from baseline during the weaning process (p = 0.001).

CONCLUSIONS

Measurements of LBI and %RC on the pneuRIP device effectively demonstrated tolerance of weaning HFNC during the recovery phase of acute respiratory failure from a respiratory infection.

Associations of respiratory mechanic instability with respiratory parameters in pediatric patients with obstructive sleep apnea syndrome

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.

Adjustment of high flow nasal cannula rates using real-time work of breathing indices in premature infants with respiratory insufficiency

OBJECTIVE

To assess the feasibility of real-time monitoring of work of breathing (WOB) indices and the impact of adjusting HFNC flow on breathing synchrony and oxygen stability in premature infants.

STUDY DESIGN

A prospective, observational study of infants stable on HFNC. The flow adjusted per predetermined algorithm. Respiratory inductive plethysmography (RIP) noninvasively measured WOB. A high-resolution pulse oximeter collected oxygen saturation and heart rate data. Summary statistics and mixed linear models were used.

RESULTS

Baseline data for 32 infants, final analysis of 21 infants. Eighty-one percent with abnormal WOB. Sixty-two percent demonstrated 20% improvement in WOB. For infants with gestational age <28 weeks, an incremental increase in HFNC flow rate decreased WOB (p < 0.001) and improved oxygen saturation and stability (p < 0.01).

CONCLUSIONS

Premature infants do not receive optimal support on HFNC. The use of a real-time feedback system to adjust HFNC is feasible and improves WOB, oxygen saturation, and oxygen stability. This technology may improve the utility of HFNC in premature infants.

Automated Assessment of Thoracic-Abdominal Asynchrony in Patients with Morquio Syndrome

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.