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Perrem L, Gaietto K, Weiner DJ, Rosenfeld M. Advances in Pediatric Lung Function Testing Techniques. Clin Chest Med 2024; 45:543-553. [PMID: 39069320 DOI: 10.1016/j.ccm.2024.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/30/2024]
Abstract
For decades spirometry has been the benchmark test for capturing lung function in children but its recognized limitations required the development of other techniques. This article introduces novel techniques in lung function assessment for pediatric patients, including multiple breath washout, impulse oscillometry, structured light plethysmography, and electrical impedance tomography, and common themes in interpreting the results. Challenges include standardization, reference data, and clinical integration of these innovative tools. Further research is ongoing to optimize these tests for clinical use, especially in diverse populations and pediatric settings.
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Affiliation(s)
- Lucy Perrem
- Department of Respiratory Medicine, Children's Health Ireland, Tallaght, Dublin 24, D24 NR0A, Ireland.
| | - Kristina Gaietto
- Division of Pulmonology, Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, 4401 Penn Avenue, Suite 9130, Rangos Building, Pittsburgh, PA 15224, USA
| | - Daniel J Weiner
- Division of Pulmonology, Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, 4401 Penn Avenue, Suite 9130, Rangos Building, Pittsburgh, PA 15224, USA
| | - Margaret Rosenfeld
- Department of Pediatrics, University of Washington School of Medicine, Seattle Children's Research Institute, Seattle Children's Hospital, 4800 Sandpoint Way Northeast, Seattle, WA 98105, USA
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Ghezzi M, Abbattista L, Dighera A, Silvestri AD, Farolfi A, Pelizzo G, Riccipetitoni G, Costanzo S, Calcaterra V, Zuccotti GV. Lung Function Evaluated By Structured Light Plethysmography in Children After Lung Surgery: A Preliminary Analysis. PEDIATRIC ALLERGY, IMMUNOLOGY, AND PULMONOLOGY 2024; 37:7-12. [PMID: 38484265 DOI: 10.1089/ped.2023.0069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
Background: Structured light plethysmography (SLP) is a novel light-based method that captures chest wall movements to evaluate tidal breathing. Methods: Thirty-two children who underwent lung surgery were enrolled. Their clinical history was collected along with spirometry and SLP. Results: Median age of surgery was 9 months (interquartile range 4-30). Most frequent diagnosis was congenital pulmonary airway malformation (14/32), then pulmonary sequestration (9/32), tumor (5/32), and bronchogenic cyst (4/32). The most frequent surgical approach was lobectomy (59%), segmentectomy (38%), and complete resection (3%). More than 80% had surgery when younger than 3 years of age. Eight patients had short-term complications (pleural effusion was the most frequent), while long-term effects were reported in 15 patients (19% recurrent cough, 13% thoracic deformities, 13% airway infections, 9% wheezing, 6% reduced exercise tolerance, and 3% columnar deformities). Spirometry was normal in 9/22 patients. Nine patients had a restrictive pattern, while 4 showed a mild bronco-reactivity. Ten patients did not perform spirometry because of young age. SLP revealed the presence of obstructive pattern in 10% of patients (IE50 > 1.88) and showed a significant difference between the two hemithorax in 29% of patients. Discussion: SLP may be a new method to evaluate lung function, without collaboration and radiation exposure, in children who underwent lung resection, also in preschool age.
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Affiliation(s)
- Michele Ghezzi
- Department of Pediatrics, "Vittore Buzzi" Children's Hospital, Milano, Italy
| | - Luisa Abbattista
- Department of Pediatrics, "Vittore Buzzi" Children's Hospital, Milano, Italy
| | - Anna Dighera
- Department of Pediatrics, "Vittore Buzzi" Children's Hospital, Milano, Italy
| | - Annalisa De Silvestri
- Department of Biometry and Clinical Epidemiology, Scientific Direction, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Andrea Farolfi
- Department of Pediatrics, "Vittore Buzzi" Children's Hospital, Milano, Italy
| | - Gloria Pelizzo
- Department of Pediatric Surgery, "Vittore Buzzi" Children's Hospital, Milano, Italy
- Department of Biomedical and Clinical Science "L. Sacco," University of Milano, Milano, Italy
| | - Giovanna Riccipetitoni
- Department of Pediatric Surgery Unit, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia
| | - Sara Costanzo
- Department of Pediatric Surgery, "Vittore Buzzi" Children's Hospital, Milano, Italy
| | - Valeria Calcaterra
- Department of Pediatrics, "Vittore Buzzi" Children's Hospital, Milano, Italy
- Pediatric and Adolescent Unit, Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy
| | - Gian Vincenzo Zuccotti
- Department of Pediatrics, "Vittore Buzzi" Children's Hospital, Milano, Italy
- Department of Biomedical and Clinical Science "L. Sacco," University of Milano, Milano, Italy
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Brolatti N, Trucco F, Ferretti M, Avanti C, Tacchetti P, Panicucci C, Striano P, Minetti C, Bruno C, Pedemonte M. Structured Light Plethysmography for Non-Invasive Assessment of Respiratory Pattern in Spinal Muscular Atrophy Type 1. J Clin Med 2023; 12:7553. [PMID: 38137621 PMCID: PMC10744161 DOI: 10.3390/jcm12247553] [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: 11/11/2023] [Revised: 12/01/2023] [Accepted: 12/03/2023] [Indexed: 12/24/2023] Open
Abstract
BACKGROUND Spinal muscular atrophy (SMA) type 1 is a severe condition leading to early respiratory failure. Treatment options have become available, yet respiratory outcome measures in SMA type 1 are limited. The aim of this study was to assess the respiratory pattern in SMA type 1 patients via structured light plethysmography (SLP). SLP measures the thoraco-abdominal movements by projecting a light grid onto the anterior thoraco-abdominal surface. METHODS Cross-sectional study of consecutive children with SMA type 1. All children underwent motor assessment (CHOP-INTEND) and one-minute tidal breathing recording by SLP in supine position while self-ventilating in room air. The Respiratory rate, the abdominal vs. chest contribution to breath (Relative Expired Abdomen%, Relative Expired Chest%) and the severity of thoraco-abdominal paradox (Phase Angle) were acquired. RESULTS Nineteen patients were included, median (IQR) age 2.3 years (1.4-7.9). Their respiratory pattern captured via SLP showed a raised median (IQR) respiratory rate per age of 33.5 bpm (26.6-41.7), a prevalent abdominal contribution to tidal breathing with median (IQR) Relative Expired Abdomen 77% (68-90) vs. Chest 23% (10-32). Thoracoabdominal paradox was detected (median Phase Angle 48.70°) and its severity correlated negatively with CHOP-INTEND (r -0.8, p < 0.01). CONCLUSIONS SLP captured and quantified the respiratory features of infants and children with SMA type 1.
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Affiliation(s)
- Noemi Brolatti
- Paediatric Neurology and Muscle Disease Unit, IRCCS Istituto Giannina Gaslini, 16147 Genova, Italy; (N.B.); (M.F.); (C.A.); (P.T.)
| | - Federica Trucco
- Paediatric Neurology and Muscle Disease Unit, IRCCS Istituto Giannina Gaslini, 16147 Genova, Italy; (N.B.); (M.F.); (C.A.); (P.T.)
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Care, University of Genova, 16132 Genova, Italy (P.S.); (C.M.); (C.B.)
| | - Marta Ferretti
- Paediatric Neurology and Muscle Disease Unit, IRCCS Istituto Giannina Gaslini, 16147 Genova, Italy; (N.B.); (M.F.); (C.A.); (P.T.)
| | - Chiara Avanti
- Paediatric Neurology and Muscle Disease Unit, IRCCS Istituto Giannina Gaslini, 16147 Genova, Italy; (N.B.); (M.F.); (C.A.); (P.T.)
| | - Paola Tacchetti
- Paediatric Neurology and Muscle Disease Unit, IRCCS Istituto Giannina Gaslini, 16147 Genova, Italy; (N.B.); (M.F.); (C.A.); (P.T.)
| | - Chiara Panicucci
- Centre of Translational and Experimental Myology, IRCCS Istituto Giannina Gaslini, 16147 Genova, Italy;
| | - Pasquale Striano
- Paediatric Neurology and Muscle Disease Unit, IRCCS Istituto Giannina Gaslini, 16147 Genova, Italy; (N.B.); (M.F.); (C.A.); (P.T.)
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Care, University of Genova, 16132 Genova, Italy (P.S.); (C.M.); (C.B.)
| | - Carlo Minetti
- Paediatric Neurology and Muscle Disease Unit, IRCCS Istituto Giannina Gaslini, 16147 Genova, Italy; (N.B.); (M.F.); (C.A.); (P.T.)
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Care, University of Genova, 16132 Genova, Italy (P.S.); (C.M.); (C.B.)
| | - Claudio Bruno
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Care, University of Genova, 16132 Genova, Italy (P.S.); (C.M.); (C.B.)
- Centre of Translational and Experimental Myology, IRCCS Istituto Giannina Gaslini, 16147 Genova, Italy;
| | - Marina Pedemonte
- Paediatric Neurology and Muscle Disease Unit, IRCCS Istituto Giannina Gaslini, 16147 Genova, Italy; (N.B.); (M.F.); (C.A.); (P.T.)
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Alhuthail E, Stockley J, Coney A, Cooper B. Measurement of breathing in patients with post-COVID-19 using structured light plethysmography (SLP). BMJ Open Respir Res 2021; 8:8/1/e001070. [PMID: 34642224 PMCID: PMC8506860 DOI: 10.1136/bmjresp-2021-001070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 09/27/2021] [Indexed: 11/18/2022] Open
Abstract
Introduction COVID-19 pandemic has had a huge impact on global health to date, with 5.6 million cases in the UK since its emergence. The respiratory symptoms largely mimic those of pneumonia’ with symptoms ranging from mild to severe. The effects on respiratory physiology are not yet fully understood, but evidence is emerging that there is much dysfunctional breathing reported but little information on tidal ventilation from the acute phase of the infection. Structured light plethysmography (SLP) is a contactless technique of respiratory function testing that measures tidal breathing parameters by assessing thoracoabdominal displacement. Methods In a postdischarge clinic, SLP was performed routinely on 110 hospitalised patients recovering from COVID-19 who had been screened for respiratory symptoms to confirm any respiratory changes occurring after the disease. Patients were categorised based on their hospital treatment in (1) the intensive therapy unit (ITU) (requiring intubation) (n=65) or (2) respiratory wards only (n=45). Data from these two patient cohorts were compared with preacquired data from healthy controls (n=30). Results We have found a significantly increased respiratory rate (p=0.006) in ITU patients compared with the healthy cohort and also a significant decrease in the inspiratory time (p=0.01), expiratory time (p=0.005) and the total breathing cycle (p=0.008). There were no significant differences between ITU and ward patients and no significant differences in healthy compared with ward patients. We examined the variability of breathing (‘entropy’) both in terms of the breath-to-breath interval and the volume-to-volume change. The breath-to-breath interval alone was significantly lower in ITU patients compared with healthy cohorts (p=0.02). Conclusion Our findings suggest that abnormalities in tidal breathing can be detected in COVID-19 recovery patients, and SLP may be a promising tool in assessing the aftermath of diseases such as COVID-19, particularly if more intensive management strategies such as mechanical ventilation are required.
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Affiliation(s)
- Eyas Alhuthail
- School of Biomedical Sciences, University of Birmingham College of Medical and Dental Sciences, Birmingham, UK.,Basic Sciences Department, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - James Stockley
- Lung Function and Sleep, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Andrew Coney
- School of Biomedical Sciences, University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
| | - Brendan Cooper
- Lung Function and Sleep, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
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Pennati F, LoMauro A, D’Angelo MG, Aliverti A. Non-Invasive Respiratory Assessment in Duchenne Muscular Dystrophy: From Clinical Research to Outcome Measures. Life (Basel) 2021; 11:life11090947. [PMID: 34575096 PMCID: PMC8468718 DOI: 10.3390/life11090947] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 09/06/2021] [Accepted: 09/06/2021] [Indexed: 12/03/2022] Open
Abstract
Ventilatory failure, due to the progressive wasting of respiratory muscles, is the main cause of death in patients with Duchenne muscular dystrophy (DMD). Reliable measures of lung function and respiratory muscle action are important to monitor disease progression, to identify early signs of ventilatory insufficiency and to plan individual respiratory management. Moreover, the current development of novel gene-modifying and pharmacological therapies highlighted the urgent need of respiratory outcomes to quantify the effects of these therapies. Pulmonary function tests represent the standard of care for lung function evaluation in DMD, but provide a global evaluation of respiratory involvement, which results from the interaction between different respiratory muscles. Currently, research studies have focused on finding novel outcome measures able to describe the behavior of individual respiratory muscles. This review overviews the measures currently identified in clinical research to follow the progressive respiratory decline in patients with DMD, from a global assessment to an individual structure–function muscle characterization. We aim to discuss their strengths and limitations, in relation to their current development and suitability as outcome measures for use in a clinical setting and as in upcoming drug trials in DMD.
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Affiliation(s)
- Francesca Pennati
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, 20133 Milano, Italy; (A.L.); (A.A.)
- Correspondence:
| | - Antonella LoMauro
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, 20133 Milano, Italy; (A.L.); (A.A.)
| | | | - Andrea Aliverti
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, 20133 Milano, Italy; (A.L.); (A.A.)
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Le Moigne G, Nazir S, Pateau V, Courtois E, L'Her E. Noninvasive Tidal Volume Measurements, Using a Time-of-Flight Camera, Under High-Flow Nasal Cannula-A Physiological Evaluation, in Healthy Volunteers. Crit Care Med 2021; 50:e61-e70. [PMID: 34259664 DOI: 10.1097/ccm.0000000000005183] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The mechanisms of high-flow nasal cannula are still debated but may be mediated by the generation of low positive end-expiratory pressure and a washout of the airway dead space. The aims of this study were to assess the effects of high-flow nasal cannula on tidal volume using a noninvasive method using a time-of-flight camera, under various conditions. DESIGN A physiologic evaluation in healthy volunteers. SETTING An university hospital ICU. SUBJECTS Ten healthy volunteers were included in a physiologic study (CamOpt study, ClinicalTrials.gov identifier: NCT04096183). INTERVENTIONS All volunteers were submitted to 12 different conditions (i.e., gas flow [baseline = 0; 30-60 L/min]; mouth [open/closed]; respiratory rate [baseline; baseline + 10 breaths/min]). Tidal volume measurements were performed every minute, during a 6-minute recording period. In all combinations, reference respiratory rate was measured by using chronometric evaluation, over a 30-second period (RRREF), and by using the time-of-flight camera (RRTOF). MEASUREMENTS AND MAIN RESULTS Tidal volume increased while increasing gas flow whatever the respiratory rate and mouth condition (p < 0.001). Similar results were observed whatever the experimental conditions (p < 0.01), except one (baseline respiratory rate + 10 breaths/min and mouth closed). Tidal volume increased while decreasing respiratory rate (p < 0.001) and mouth closing (p < 0.05). Proportion of tidal volume greater than 10, 15, and 20 mL/kg changed while increasing the flow. RRTOF was in agreement with RRREF (intraclass correlation coefficient, 0.96), with a low mean bias (0.55 breaths/min) and acceptable deviation. CONCLUSIONS Time-of-flight enables to detect tidal volume changes under various conditions of high-flow nasal cannula application. Tidal volume increased significantly while increasing gas flow and mouth closing. Such technique might be useful to monitor the risk of patient self-inflicted lung injury or under assistance.
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Affiliation(s)
- Guillaume Le Moigne
- Département de Médecine d'Urgence, CHRU de La Cavale Blanche, Brest, France. LATIM INSERM UMR 1101, FHU TechSan, Université de Bretagne Occidentale, Brest, France. Médecine Intensive et Réanimation, CHRU de La Cavale Blanche, Brest, France. UGD DRCI, CHRU de La Cavale Blanche, Brest, France
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Motamedi-Fakhr S, Iles R, Barker N, Alexander J, Cooper BG. Reference equations for tidal breathing parameters using structured light plethysmography. ERJ Open Res 2021; 7:00050-2021. [PMID: 34109249 PMCID: PMC8184162 DOI: 10.1183/23120541.00050-2021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 02/25/2021] [Indexed: 12/01/2022] Open
Abstract
Tidal breathing measurements can be used to identify changes in respiratory status. Structured light plethysmography (SLP) is a non-contact tidal breathing measurement technique. Lack of reference equations for SLP parameters makes clinical decision-making difficult. We have developed a set of growth-adjusted reference equations for seven clinically pertinent parameters of respiratory rate (fR), inspiratory time (tI), expiratory time (tE), duty cycle (tI/total breath time), phase (thoraco-abdominal asynchrony (TAA)), relative thoracic contribution (RTC) and tidal inspiratory/expiratory flow at 50% volume (IE50). Reference equations were developed based on a cohort of 198 seated healthy subjects (age 2–75 years, height 82–194 cm, 108 males). We adopted the same methodological approach as the Global Lung Function Initiative (GLI) report on spirometric reference equations. 5 min of tidal breathing was recorded per subject. Parameters were summarised with their medians. The supplementary material provided is an integral part of this work and a reference range calculator is provided therein. We found predicted fR to decrease with age and height rapidly in the first 20 years and slowly thereafter. Expected tI, tE and RTC followed the opposite trend. RTC was 6.7% higher in females. Duty cycle increased with age, peaked at 13 years and decreased thereafter. TAA was high and variable in early life and declined rapidly with age. Predicted IE50 was constant, as it did not correlate with growth. These reference ranges for seven key measures ensure that clinicians and researchers can identify tidal breathing patterns in disease and better understand and interpret SLP and tidal breathing data. A set of reference equations for seven key tidal breathing parameters measured using structured light plethysmography (SLP) to help clinicians better understand and interpret SLP data and the value of tidal breathing patternshttps://bit.ly/2Og2H3h
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Affiliation(s)
| | - Richard Iles
- Respiratory Paediatrics, Evelina Children's Hospital, London, UK
| | - Nicki Barker
- Respiratory Medicine, Sheffield Children's NHS Foundation Trust, Sheffield, UK
| | - John Alexander
- Paediatric Intensive Care, University Hospitals of North Midlands, Stoke-on-Trent, UK
| | - Brendan G Cooper
- Lung Function and Sleep, Queen Elizabeth Hospital, Birmingham, UK
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L'Her E, Nazir S, Pateau V, Visvikis D. Accuracy of noncontact surface imaging for tidal volume and respiratory rate measurements in the ICU. J Clin Monit Comput 2021; 36:775-783. [PMID: 33886075 PMCID: PMC8060689 DOI: 10.1007/s10877-021-00708-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 04/13/2021] [Indexed: 01/24/2023]
Abstract
Tidal volume monitoring may help minimize lung injury during respiratory assistance. Surface imaging using time-of-flight camera is a new, non-invasive, non-contact, radiation-free, and easy-to-use technique that enables tidal volume and respiratory rate measurements. The objectives of the study were to determine the accuracy of Time-of-Flight volume (VTTOF) and respiratory rate (RRTOF) measurements at the bedside, and to validate its application for spontaneously breathing patients under high flow nasal canula. Data analysis was performed within the ReaSTOC data-warehousing project (ClinicalTrials.gov identifier NCT02893462). All data were recorded using standard monitoring devices, and the computerized medical file. Time-of-flight technique used a Kinect V2 (Microsoft, Redmond, WA, USA) to acquire the distance information, based on measuring the phase delay between the emitted light-wave and received backscattered signals. 44 patients (32 under mechanical ventilation; 12 under high-flow nasal canula) were recorded. High correlation (r = 0.84; p < 0.001), with low bias (-1.7 mL) and acceptable deviation (75 mL) was observed between VTTOF and VTREF under ventilation. Similar performance was observed for respiratory rate (r = 0.91; p < 0.001; bias < 1b/min; deviation ≤ 5b/min). Measurements were possible for all patients under high-flow nasal canula, detecting overdistension in 4 patients (tidal volume > 8 mL/kg) and low ventilation in 6 patients (tidal volume < 6 mL/kg). Tidal volume monitoring using time-of-flight camera (VTTOF) is correlated to reference values. Time-of-flight camera enables continuous and non-contact respiratory monitoring under high-flow nasal canula, and enables to detect tidal volume and respiratory rate changes, while modifying flow. It enables respiratory monitoring for spontaneously patients, especially while using high-flow nasal oxygenation.
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Affiliation(s)
- Erwan L'Her
- Médecine Intensive Et Réanimation, CHRU de La Cavale Blanche, Bvd. Tanguy-Prigent, 29609, BREST Cedex, France. .,LATIM INSERM UMR 1101, Université de Bretagne Occidentale, BREST, France.
| | - Souha Nazir
- LATIM INSERM UMR 1101, Université de Bretagne Occidentale, BREST, France
| | - Victoire Pateau
- Médecine Intensive Et Réanimation, CHRU de La Cavale Blanche, Bvd. Tanguy-Prigent, 29609, BREST Cedex, France
| | - Dimitris Visvikis
- LATIM INSERM UMR 1101, Université de Bretagne Occidentale, BREST, France
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