In vitro assessment of equipment and software to assess tidal breathing parameters in infants

The aim of this in vitro study was to compare the measurement accuracy of two currently available devices for measuring tidal breathing in infants. A mechanical model pump was used to generate flow profiles which simulated those observed in infants. A range of flows was applied simultaneously to two different devices, namely the commercially available SensorMedics 2600 (SM 2600) and more recently developed, custom-made equipment based on the flow-through technique (FTT). Automatically derived values from both devices were compared with one another and with manual calculations of printouts of the same breaths. There were no differences in the raw flow signal obtained from the two devices, nor between values calculated automatically or manually from the FTT. Similarly, the deviations between the FTT and SM 2600 were <3% for tidal volume, respiratory frequency and minute ventilation. However, when comparing either with manually calculated values or those derived automatically from the FTT, there was a systematic and highly significant underestimation of shape-dependent parameters, such as the time to peak tidal expiratory flow as a proportion of tidal expiratory time (tPTEF/tE), derived by the SM 2600. The lower the applied flow, the higher the observed deviations, the underestimation being up to 60% when flows simulating those observed in preterm neonates were applied. These errors appear to result from differences in signal processing such as the algorithms used for breath detection and can only be detected if appropriate nonsinusoidal flow profiles representing those seen in infants are used to evaluate equipment.

Leak measurements in spontaneously breathing premature newborns by using the flow-through technique

A new method for measuring and correcting air leaks during lung-function testing in infants has been validated in vitro and in vivo by using a flow-through system that measured the inflow and outflow of a face mask. An adjustable leak was quantified by using suction flow to validate the accuracy of leak measurements. To validate the leak correction, the volume of a pump was measured with different air leaks (0-30%). The method developed was tested in 67 infants breathing spontaneously. There was good agreement between measured and simulated leaks (r = 0.998, P < 0.001; 95% limits of agreement were -0.3 and 0.1%, respectively). The volume was generally underestimated because of leaks, and the volume error was up to 94% compared with the maximum error of 5% after leak correction. With continuous leak measurements in vivo, there were <4% actual leaks (median 2.6%), and we did not observe any leaks in >7% of cases. The leak correction improved the accuracy of ventilatory measurements. The monitoring of leaks is helpful for airtight placement of the face mask and for prevention of serious measurement errors caused by leaks.