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Acosta CM, Poliotto S, Abrego D, Bradley D, de Esteban S, Mir F, Ricci L, Natal M, Wallin M, Hallbäck M, Sipmann FS, Tusman G. Effect of an Individualized Lung Protective Ventilation on Lung Strain and Stress in Children Undergoing Laparoscopy: An Observational Cohort Study. Anesthesiology 2024; 140:430-441. [PMID: 38064715 DOI: 10.1097/aln.0000000000004856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2024]
Abstract
BACKGROUND Exaggerated lung strain and stress could damage lungs in anesthetized children. The authors hypothesized that the association of capnoperitoneum and lung collapse in anesthetized children increases lung strain-stress. Their primary aim was to describe the impact of capnoperitoneum on lung strain-stress and the effects of an individualized protective ventilation during laparoscopic surgery in children. METHODS The authors performed an observational cohort study in healthy children aged 3 to 7 yr scheduled for laparoscopic surgery in a community hospital. All received standard protective ventilation with 5 cm H2O of positive end-expiratory pressure (PEEP). Children were evaluated before capnoperitoneum, during capnoperitoneum before and after lung recruitment and optimized PEEP (PEEP adjusted to get end-expiratory transpulmonary pressure of 0), and after capnoperitoneum with optimized PEEP. The presence of lung collapse was evaluated by lung ultrasound, positive Air-Test (oxygen saturation measured by pulse oximetry 96% or less breathing 21% O2 for 5 min), and negative end-expiratory transpulmonary pressure. Lung strain was calculated as tidal volume/end-expiratory lung volume measured by capnodynamics, and lung stress as the end-inspiratory transpulmonary pressure. RESULTS The authors studied 20 children. Before capnoperitoneum, mean lung strain was 0.20 ± 0.07 (95% CI, 0.17 to 0.23), and stress was 5.68 ± 2.83 (95% CI, 4.44 to 6.92) cm H2O. During capnoperitoneum, 18 patients presented lung collapse and strain (0.29 ± 0.13; 95% CI, 0.23 to 0.35; P < 0.001) and stress (5.92 ± 3.18; 95% CI, 4.53 to 7.31 cm H2O; P = 0.374) increased compared to before capnoperitoneum. During capnoperitoneum and optimized PEEP, children presenting lung collapse were recruited and optimized PEEP was 8.3 ± 2.2 (95% CI, 7.3 to 9.3) cm H2O. Strain returned to values before capnoperitoneum (0.20 ± 0.07; 95% CI, 0.17 to 0.22; P = 0.318), but lung stress increased (7.29 ± 2.67; 95% CI, 6.12 to 8.46 cm H2O; P = 0.020). After capnoperitoneum, strain decreased (0.18 ± 0.04; 95% CI, 0.16 to 0.20; P = 0.090), but stress remained higher (7.25 ± 3.01; 95% CI, 5.92 to 8.57 cm H2O; P = 0.024) compared to before capnoperitoneum. CONCLUSIONS Capnoperitoneum increased lung strain in healthy children undergoing laparoscopy. Lung recruitment and optimized PEEP during capnoperitoneum decreased lung strain but slightly increased lung stress. This little rise in pulmonary stress was maintained within safe, lung-protective, and clinically acceptable limits. EDITOR’S PERSPECTIVE
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Affiliation(s)
- Cecilia M Acosta
- Department of Anesthesiology, Hospital Privado de Comunidad, Mar del Plata, Argentina
| | - Sergio Poliotto
- Department of Pediatric Surgery, Hospital Privado de Comunidad, Mar del Plata, Argentina
| | - Diego Abrego
- Department of Pediatric Surgery, Hospital Privado de Comunidad, Mar del Plata, Argentina
| | - Dolores Bradley
- Department of Anesthesiology, Hospital Privado de Comunidad, Mar del Plata, Argentina
| | - Santiago de Esteban
- Department of Anesthesiology, Hospital Privado de Comunidad, Mar del Plata, Argentina
| | - Francisco Mir
- Department of Anesthesiology, Hospital Privado de Comunidad, Mar del Plata, Argentina
| | - Lila Ricci
- Department of Mathematics, Facultad de Ciencias Exactas, Universidad Nacional de Mar del Plata, Argentina
| | - Marcela Natal
- Department of Mathematics, Facultad de Ciencias Exactas, Universidad Nacional de Mar del Plata, Argentina
| | - Mats Wallin
- Department of Physiology and Pharmacology, Karolinska Institute, Stockholm, Sweden; Getinge Critical Care AB, Solna, Sweden
| | | | - Fernando Suarez Sipmann
- Hedenstierna Laboratory, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden; CIBERES (Network Biomedical Research Center), Madrid, Spain; Department of Critical Care, Hospital Universitario de La Princesa, Universidad Autonoma de Madrid, Madrid, Spain
| | - Gerardo Tusman
- Department of Anesthesiology, Hospital Privado de Comunidad, Mar del Plata, Argentina
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Greenough A, Pahuja A. Updates on Functional Characterization of Bronchopulmonary Dysplasia - The Contribution of Lung Function Testing. Front Med (Lausanne) 2015; 2:35. [PMID: 26131449 PMCID: PMC4469111 DOI: 10.3389/fmed.2015.00035] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Accepted: 05/14/2015] [Indexed: 11/24/2022] Open
Abstract
Bronchopulmonary dysplasia (BPD) is a chronic lung disease that predominantly affects prematurely born infants. Initially, BPD was described in infants who had suffered severe respiratory failure and required high pressure, mechanical ventilation with high concentrations of supplementary oxygen. Now, it also occurs in very prematurely born infants who initially had minimal or even no signs of lung disease. These differences impact the nature of the lung function abnormalities suffered by “BPD” infants, which are also influenced by the criteria used to diagnose BPD and the oxygen saturation level used to determine the supplementary oxygen requirement. Key also to interpreting lung function data in this population is whether appropriate lung function tests have been used and in an adequately sized population to make meaningful conclusions. It should also be emphasized that BPD is a poor predictor of long-term respiratory morbidity. Bearing in mind those caveats, studies have consistently demonstrated that infants who develop BPD have low compliance and functional residual capacities and raised resistances in the neonatal period. There is, however, no agreement with regard to which early lung function measurement predicts the development of BPD, likely reflecting different techniques were used in different populations in often underpowered studies. During infancy, lung function generally improves, but importantly airflow limitation persists and small airway function appears to decline. Improvements in lung function following administration of diuretics or bronchodilators have not translated into long-term improvements in respiratory outcomes. By contrast, early differences in lung function related to different ventilation modes have led to investigation and demonstration that prophylactic, neonatal high-frequency oscillation appears to protect small airway function.
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Affiliation(s)
- Anne Greenough
- Division of Asthma, Allergy and Lung Biology, MRC and Asthma UK Centre in Allergic Mechanisms of Asthma, King's College London , London , UK ; NIHR Biomedical Research Centre, Guy's and St. Thomas NHS Foundation Trust , London , UK
| | - Anoop Pahuja
- Neonatal Intensive Care Centre, King's College Hospital NHS Foundation Trust , London , UK
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Prediction of Pulmonary Restriction from Forced Vital Capacity in Elderly is Similar Using GLI and ERS Equations. Lung 2014; 192:775-9. [DOI: 10.1007/s00408-014-9627-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Accepted: 07/10/2014] [Indexed: 11/27/2022]
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Schmalisch G, Wilitzki S, Roehr CC, Proquitté H, Bührer C. Differential effects of immaturity and neonatal lung disease on the lung function of very low birth weight infants at 48-52 postconceptional weeks. Pediatr Pulmonol 2013; 48:1214-23. [PMID: 23401477 DOI: 10.1002/ppul.22770] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2012] [Accepted: 12/06/2012] [Indexed: 11/09/2022]
Abstract
BACKGROUND The pathogenesis of chronic lung disease of prematurity involves maturational arrest and neonatal lung disease (NLD) followed by mechanical ventilation (MV). However, the effect of these factors on postnatal lung function is not well established. Therefore, the aim of this study was to examine the differential effects of immaturity and NLD requiring MV on lung function test (LFT) parameters within 4 months after discharge. PATIENTS AND METHODS A total of 386 very low birth weight (VLBW) infants (birth weight <1,500 g) were examined at a median postmenstrual age of 49 weeks. Two hundred twenty-six infants (59%) were born before the 28th week of gestation, and 247 infants (64%) had NLD requiring invasive MV. LFTs included tidal breathing measurements, measurement of respiratory mechanics assessed by occlusion test, body plethysmography, SF6 multiple breath washout, forced expiratory flow (VmaxFRC') by rapid thoraco-abdominal compression technique, end-expiratory CO2 (Pet CO2 ), exhaled NO (FeNO), and arterialized capillary blood gas analysis. MAIN RESULTS Multivariate analysis indicated that severe immaturity was mainly associated with changes in the breathing pattern (reduced tidal volume (P = 0.003) and increased respiratory rate (P = 0.03)), a reduced VmaxFRC' (P = 0.004) and lower respiratory compliance (P < 0.001). NLD requiring MV, but not immaturity, was significantly and independently associated with increased respiratory and airway resistances (both P = 0.003), reduced FRCSF6 (P = 0.03), increased Pet CO2 (P = 0.019) and lower FeNO (P < 0.001). Both immaturity and NLD requiring MV caused a lower paO2 (P < 0.001) and higher a paCO2 . CONCLUSIONS Lung function after discharge of VLBW infants is differentially affected by both immaturity and NLD requiring MV. With increasing prematurity, intubated and mechanically ventilated infants are at increased risk of developing impaired lung function which can be detected by LFT.
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Affiliation(s)
- Gerd Schmalisch
- Department of Neonatology, Charité University Medical Center, Berlin, Germany.
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Scarlata S, Costanzo L, Giua R, Pedone C, Incalzi RA. Diagnosis and prognostic value of restrictive ventilatory disorders in the elderly: A systematic review of the literature. Exp Gerontol 2012; 47:281-9. [DOI: 10.1016/j.exger.2012.02.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2011] [Revised: 02/09/2012] [Accepted: 02/10/2012] [Indexed: 10/28/2022]
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Lum S, Hoo AF, Hulskamp G, Wade A, Stocks J. Potential misinterpretation of infant lung function unless prospective healthy controls are studied. Pediatr Pulmonol 2010; 45:906-13. [PMID: 20648666 DOI: 10.1002/ppul.21255] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
UNLABELLED SUMMARY RATIONALE: Reliable interpretation of pulmonary function tests relies on appropriate reference data, which remain very limited for infants. OBJECTIVES This study aimed to assess the validity of published reference equations for forced expiratory flow-volume (FEFV) data in infants when using current, commercially available equipment, and how this could impact on interpretation of results from infants with lung disease. METHODS The Jaeger Masterscreen BabyBody (v4.67) equipment was used to perform partial and raised volume FEFV maneuvers in healthy infants and those with cystic fibrosis (CF). Results were initially expressed as Z-scores using published reference equations. Multilevel modeling was used to calculate differences, if any, from predicted scores in healthy infants. RESULTS Data were available from 66 healthy full term infants on 89 test occasions; [median (range) postnatal age 49.4 (12-101) weeks. All FEFV outcomes were significantly lower than predicted, with mean (SD) Z-score differences of -0.4 (1.1) for FVC; -0.6 (1.0) for FEV(0.5); -1.0 (1.0) for FEF(25-75) and -1.4 (1.1) for V'(maxFRC). After adjustments using multilevel modeling, mean Z-scores were within 0.1 (SD approximately 1.0) predicted for all outcomes in healthy infants. Among 50 infants with CF, studied on 85 test occasions, results were "abnormal" (<-1.96 Z-scores) on 35 (41%) and 37 (45%) test occasions for FEV(0.5) and FEF(25-75), respectively, when using published equations. This fell to 24 (28%) and 20 (24%), respectively, after adjustment. CONCLUSIONS Dependence on published equations for interpreting FEFV data in infants may lead to misinterpretation of lung function status, which could impact adversely both in the research setting and on clinical management. Use of a contemporary control group or establishment of equipment-specific reference data is essential for meaningful interpretation of infant lung function data.
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Affiliation(s)
- Sooky Lum
- Portex Unit, Respiratory Physiology and Medicine, UCL, Institute of Child Health, London, UK.
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Morris MG. Comprehensive integrated spirometry using raised volume passive and forced expirations and multiple-breath nitrogen washout in infants. Respir Physiol Neurobiol 2010; 170:123-40. [PMID: 19897058 PMCID: PMC2858579 DOI: 10.1016/j.resp.2009.10.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2009] [Revised: 10/29/2009] [Accepted: 10/29/2009] [Indexed: 12/15/2022]
Abstract
With the rapid somatic growth and development in infants, simultaneous accurate measurements of lung volume and airway function are essential. Raised volume rapid thoracoabdominal compression (RTC) is widely used to generate forced expiration from an airway opening pressure of 30 cmH(2)O (V(30)). The (dynamic) functional residual capacity (FRC(dyn)) remains the lung volume most routinely measured. The aim of this study was to develop comprehensive integrated spirometry that included all subdivisions of lung volume at V(30) or total lung capacity (TLC(30)). Measurements were performed on 17 healthy infants aged 8.6-119.7 weeks. A commercial system for multiple-breath nitrogen washout (MBNW) to measure lung volumes and a custom made system to perform RTC were used in unison. A refined automated raised volume RTC and the following two novel single maneuvers with dual volume measurements were performed from V(30) during a brief post-hyperventilation apneic pause: (1) the passive expiratory flow was integrated to produce the inspiratory capacity (IC) and the static (passive) FRC (FRC(st)) was estimated by initiating MBNW after end-passive expiration; (2) RTC was initiated late during passive expiration, flow was integrated to produce the slow vital capacity ((j)SVC) and the residual volume (RV) was measured by initiating MBNW after end-expiration while the jacket (j) was inflated. Intrasubject FRC(dyn) and FRC(st) measurements overlapped (p=0.6420) but neither did with the RV (p<0.0001). Means (95% confidence interval) of FRC(dyn), IC, FRC(st), (j)SVC, RV, forced vital capacity and tidal volume were 21.2 (19.7-22.7), 36.7 (33.0-40.4), 21.2 (19.6-22.8), 40.7 (37.2-44.2), 18.1 (16.6-19.7), 40.7 (37.1-44.2) and 10.2 (9.6-10.7)ml/kg, respectively. Static lung volumes and capacities at V(30) and variables from the best forced expiratory flow-volume curve were dependent on age, body length and weight. In conclusion, we developed a comprehensive physiologically integrated approach for in-depth investigation of lung function at V(30) in infants.
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Affiliation(s)
- Mohy G Morris
- Department of Pediatrics, Pulmonary Medicine Section, College of Medicine, University of Arkansas for Medical Sciences, Arkansas Children's Hospital Research Institute, Little Rock, AR 72202, USA.
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Broughton S, Thomas MR, Marston L, Calvert SA, Marlow N, Peacock JL, Rafferty GF, Greenough A. Very prematurely born infants wheezing at follow-up: lung function and risk factors. Arch Dis Child 2007; 92:776-80. [PMID: 17715441 PMCID: PMC2084021 DOI: 10.1136/adc.2006.112623] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To determine whether abnormalities of lung volume and/or airway function were associated with wheeze at follow-up in infants born very prematurely and to identify risk factors for wheeze. DESIGN Lung function data obtained at 1 year of age were collated from two cohorts of infants recruited into the UKOS and an RSV study, respectively. SETTING Infant pulmonary function laboratory. PATIENTS 111 infants (mean gestational age 26.3 (SD 1.6) weeks). INTERVENTIONS Lung function measurements at 1 year of age corrected for gestational age at birth. Diary cards and respiratory questionnaires were completed to document wheeze. MAIN OUTCOME MEASURES Functional residual capacity (FRC(pleth) and FRC(He)), airways resistance (R(aw)), FRC(He):FRC(pleth) and tidal breathing parameters (T(PTEF):T(E)). RESULTS The 60 infants who wheezed at follow-up had significantly lower mean FRC(He), FRC(He):FRC(pleth) and T(PTEF):T(E), but higher mean R(aw) than the 51 without wheeze. Regression analysis demonstrated that gestational age, length at assessment, family history of atopy and a low FRC(He):FRC(pleth) were significantly associated with wheeze. CONCLUSIONS Wheeze at follow-up in very prematurely born infants is associated with gas trapping, suggesting abnormalities of the small airways.
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Affiliation(s)
- Simon Broughton
- MRC-Asthma Centre, Division of Asthma, Allergy and Lung Biology, King's College London, London, UK
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Broughton S, Rafferty GF, Milner AD, Greenough A. Effect of electronic compensation on plethysmographic airway resistance measurements. Pediatr Pulmonol 2007; 42:764-72. [PMID: 17659604 DOI: 10.1002/ppul.20661] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
OBJECTIVES To compare the performance of a plethysmograph which incorporated electronic compensation (Jaeger) to one which incorporated a heated humidified breathing system (Hammersmith plethysmograph). WORKING HYPOTHESIS The performance of a plethysmograph which incorporated electronic compensation would be impaired compared to that which incorporated a heated humidified system. STUDY DESIGN In vitro and in vivo comparison. PATIENT SELECTION Eleven children, median postnatal age 13 (range 5-15) months. METHODS In vitro, the plethysmographs were assessed using known resistances (1.94, 4.85, and 6.80 kPa, equivalent to 20, 50, and 70 cm H(2)O/L/sec, respectively). In vivo, comparison was made of the results of children studied in both plethysmographs. RESULTS In vitro, the resistance results of the two plethysmographs were similar to each other and to the known resistances. In vivo, the median "effective" airways resistance result of the Jaeger (4.15 kPa/L/sec) was significantly higher than the inspiratory resistance of the Hammersmith plethysmograph (3.0 kPa/L/sec), but the median inspiratory resistances of the Jaeger were significantly lower than those of the Hammersmith plethysmograph (2.8 kPa/L/sec vs. 3.0 kPa/L/sec). The mean within patient coefficient of variability for inspiratory resistance of the Jaeger plethysmograph (16.7%) was significantly higher than that of the Hammersmith plethysmograph (11.6%) (P = 0.014). CONCLUSION These results suggest plethysmographs which incorporate electronic compensation may be inappropriate for use in infants and very young children.
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Affiliation(s)
- Simon Broughton
- Division of Asthma, Allergy and Lung Biology, King's College London-MRC Asthma Centre, London, United Kingdom
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