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Ann R. Stark – 1st expert on this subject based on the ideXlab platform

  • Changes in the contribution of the rib cage to tidal breathing during infancy.
    The American review of respiratory disease, 1990
    Co-Authors: M. B. Hershenson, Andrew A. Colin, Mary Ellen B. Wohl, Ann R. Stark

    Abstract:

    As the shape, compliance, and deformability of the rib cage (RC) change during infancy, RC participation in quiet breathing may increase. We used respiratory inductive plethysmography (RIP) to determine the relative contributions of the RC and abdomen (AB) to tidal volume (Vt) in 20 studies in 14 healthy infants 1 to 26 months of age during quiet natural sleep. RIP was calibrated with simultaneous flow measurements (Anesthesia Mask and pneumotachograph) by the least squares method of statistical analysis. We analyzed segments of breathing with and without flow measurement for RIP-derived Vt, change in RC volume (Vrc) and AB volume (Vab) with each breath and the RC contribution to tidal breathing (%RC = Vrc/Vrc + Vab). The %RC increased with age: %RC = 1.4 age (months) + 33 (r = 0.69, p < 0.01). After 9 months of age, %RC resembled that found in quietly sleeping adolescents. Mask placement increased Vt in all but one subject (mean increase, 29 ± 23% of baseline ± SD; p < 0.001, paired t test). In infants y...

  • Changes in the contribution of the rib cage to tidal breathing during infancy.
    The American review of respiratory disease, 1990
    Co-Authors: M. B. Hershenson, Andrew A. Colin, Mary Ellen B. Wohl, Ann R. Stark

    Abstract:

    As the shape, compliance, and deformability of the rib cage (RC) change during infancy, RC participation in quiet breathing may increase. We used respiratory inductive plethysmography (RIP) to determine the relative contributions of the RC and abdomen (AB) to tidal volume (VT) in 20 studies in 14 healthy infants 1 to 26 months of age during quiet natural sleep. RIP was calibrated with simultaneous flow measurements (Anesthesia Mask and pneumotachograph) by the least squares method of statistical analysis. We analyzed segments of breathing with and without flow measurement for RIP-derived VT, change in RC volume (Vrc) and AB volume (Vab) with each breath and the RC contribution to tidal breathing (%RC = Vrc/Vrc + Vab). The %RC increased with age: %RC = 1.4 age (months) + 33 (r = 0.69, p less than 0.01). After 9 months of age, %RC resembled that found in quietly sleeping adolescents. Mask placement increased VT in all but one subject (mean increase, 29 +/- 23% of baseline +/- SD; p less than 0.001, paired t test). In infants younger than 10 months of age, Mask placement also increased %RC (without Mask, 40 +/- 9%; with Mask, 46 +/- 10% p less than 0.02). We conclude that by 1 yr of age, the RC contribution to tidal breathing during quiet sleep is similar to that of the adolescent, suggesting that major developmental changes in RC shape, compliance, and deformability take place during infancy.

Christopher Randolph – 2nd expert on this subject based on the ideXlab platform

  • Aerosol Therapy with Valved Holding Chambers in Young Children, Importance of a Face Mask Seal
    Pediatrics, 2002
    Co-Authors: Christopher Randolph

    Abstract:

    Purpose of the Study. The purpose of this study was to determine the relative ability of 3 different spacers with Masks to obtain a tight seal. The Nebuchamber (Astra Draco AB, Lund, Sweden), the AeroChamber (Trudell Medical, London, Ontario, Canada), and the Babyhaler (Glaxo GmbH, Germany) were compared with the Hans Rudolph Anesthesia Mask in infants and young children. Masks are viewed as a critical interface between the valved holding chamber and the small child for providing aerosol treatments.

    Study Population. The study population included 30 children with …

Michael T. Newhouse – 3rd expert on this subject based on the ideXlab platform

  • Aerosol Therapy With Valved Holding Chambers in Young Children: Importance of the FaceMask Seal
    Pediatrics, 2001
    Co-Authors: Israel Amirav, Michael T. Newhouse

    Abstract:

    Objective. Masks are an essential interface between valved holding chambers (VHCs), or spacers, and a small child9s face for providing aerosol therapy. Clinical experience suggests that many young children do not cooperate with the VHC treatment or tolerate a Mask of any kind. This might impair the Mask–face seal and reduce the dose delivered to the child. The objective of this study was to evaluate the ability of parents to provide a good Mask–face seal in infants and toddlers using 3 Masks provided with commonly used pediatric VHCs and compare this with the seal obtained with the Hans Rudolph pediatric Anesthesia Mask. Methods. A preliminary in vitro filter study was conducted to validate the assumption that reduced ventilation as a result of increased faceMask leak reduces the drug aerosol dose delivered to the mouth. FaceMask leak then was studied in vivo for NebuChamber, AeroChamber, BabyHaler, and Hans Rudolph Masks by measuring ventilation with an in-line pneumotachograph while the faceMask was held in place by experienced parents who were asked to demonstrate how they deliver medication to their children without any additional instruction. Thirty children (mean age: 3.2 ± 1.4 years) performed 4 repeat studies with each Mask. The first 10 patients performed the tests once again within 1 month. On the second occasion, the parents were coached continuously and encouraged to hold the Mask tightly against the child9s face. Results. The AeroChamber and Hans Rudolph Masks provided the best seal as reflected in the magnitude of the ventilation measured through them. The NebuChamber provided the poorest seal, with 45% less ventilation than the AeroChamber and Hans Rudolph Masks. There was considerable intraindividual variability for all Masks (24% to 48%); however, the variability with the NebuChamber Mask was 2-fold greater than the other Masks. All ventilatory volumes during the coached session were significantly greater than during the uncoached session. Variability during the coached session was significantly less (except for the BabyHaler, which remained unchanged). Conclusions. VHCs with Masks designed for use with small children may provide a poor seal with the face, leading to reduced or more variable dose delivery. The faceMask seal is critical for efficient aerosol delivery to infants and young children, and this should be stressed to parents.