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Sherry E Courtney - One of the best experts on this subject based on the ideXlab platform.
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work of breathing in premature neonates noninvasive neurally adjusted ventilatory assist versus noninvasive ventilation
Respiratory Care, 2020Co-Authors: David N Matlock, Shasha Bai, Michael D Weisner, Norman Comtois, Jennifer Beck, Sherry E CourtneyAbstract:BACKGROUND: We tested whether work of breathing in premature newborns estimated by phase angle (θ) by using Respiratory Inductance Plethysmography is decreased during neurally-adjusted ventilatory assist (NAVA) noninvasive ventilation (NIV) versus NIV alone. METHODS: NAVA NIV and NIV were applied in random order while using Respiratory Inductance Plethysmography to measure the phase angle. RESULTS: Patient-ventilator asynchrony was decreased during NAVA NIV; however, the phase angle was not different between the modes. A large number of repeated assists with switches to backup were found when using NAVA NIV. Results of the analysis indicated these were due to the apnea alarm limit set during NAVA NIV. CONCLUSIONS: The improvement in patient-ventilator synchrony supports the hypothesis that work of breathing may be decreased with NAVA NIV; however, we were unable to demonstrate this with our study design. Short apnea time settings with NAVA NIV led to a large number of switches to backup and repeated assists during the same neural effort. (ClinicalTrials.gov registration NCT02788110.)
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prone versus supine positioning in the well preterm infant effects on work of breathing and breathing patterns
Pediatric Pulmonology, 2006Co-Authors: Jennifer Levy, Robert H Habib, Ellina Liptsen, Andrew M Steele, Rachana Singh, Doron J Kahn, Sherry E CourtneyAbstract:Summary. Premature infants with Respiratory distress oxygenate better and have improved breathing synchrony when theyare nursed in the prone position. We investigated whether workof breathing(WOB)isdecreasedinthepronepositioninhealthyprematureinfantsnearingdischarge from the neonatal intensive care unit. Nineteen convalescing premature infants in room air were studied in both supine and prone position. Positioning order was randomized. Mean birth weight was1358 � 332(SD)g,gestationalage29.7 � 2.1weeks,weightatstudy1757 � 248g,andageat study 33.6 � 1.4 days. Calibrated Respiratory Inductance Plethysmography (RIP) was used to measuretidalvolume;anesophagealcatheterestimatedpleuralpressure.Inspiratory,elastic,and resistive WOB were calculated and were unaffected by proneversus supinepositioning(P ¼0.46, 0.36, and 0.87, respectively). Similarly, Respiratory rate, tidal volume, minute ventilation, and lung compliance did not differ between positions. These data suggest that sleep position recommendations for healthy premature infants discharged home without oxygen should be no different than for term infants. Pediatr Pulmonol. 2006; 41:754–758. 2006 Wiley-Liss, Inc.
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work of breathing during nasal continuous positive airway pressure in preterm infants a comparison of bubble vs variable flow devices
Journal of Perinatology, 2005Co-Authors: Ellina Liptsen, J G Saslow, Zubair H. Aghai, Kee H Pyon, Robert H Habib, Tarek Nakhla, Jennifer Long, Andrew M Steele, Sherry E CourtneyAbstract:To compare work of breathing and breathing asynchrony during bubble nasal continuous positive airway pressure (NCPAP) vs variable-flow (VF)-NCPAP in premature infants. We studied 18 premature infants of birth weight <1500 g who required NCPAP for mild Respiratory distress. Each infant was studied on bubble and VF-NCPAP at 8, 6, 4, and 0 cmH2O. Tidal volumes were obtained by calibrated Respiratory Inductance Plethysmography. Esophageal pressure estimated intrapleural pressure. Inspiratory and resistive work of breathing were calculated from pressure–volume data. Breathing asynchrony was assessed with phase angle. The results at all NCPAP levels were referenced to VF-NCPAP values at 8 cmH2O. Provision of NCPAP with either device decreased inspiratory work of breathing, tidal volume, and minute ventilation relative to NCPAP of 0 cmH2O. Bubble NCPAP did not decrease resistive work of breathing relative to 0 cmH2O. Resistive work of breathing (p=0.01), Respiratory rate (p<0.03), and phase angle (p=0.002) were all greater with bubble compared to VF-NCPAP. The more labored and asynchronous breathing seen with bubble NCPAP may lead to higher failure rates over the long term than with VF-NCPAP.
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lung recruitment and breathing pattern during variable versus continuous flow nasal continuous positive airway pressure in premature infants an evaluation of three devices
Pediatrics, 2001Co-Authors: Sherry E Courtney, J G Saslow, Kee H Pyon, Paresh B Pandit, Gerald K Arnold, Robert H HabibAbstract:Objective. To determine whether lung volume changes and breathing pattern parameters differ among 3 devices for delivery of nasal continuous positive airway pressure (CPAP) in premature infants. Methods. Thirty-two premature infants receiving nasal CPAP for apnea or mild Respiratory distress were enrolled. Birth weight was (mean ± standard deviation) 1081 ± 316 g, gestational age 29 ± 2 weeks, age at study 13 ± 12 days, and fraction of inspired oxygen (Fio2) at study .29 ± .1. Three devices, applied in random order, were studied in each infant: continuous flow nasal CPAP via CPAP prongs, continuous flow nasal CPAP via modified nasal cannula, and variable flow nasal CPAP. After lung recruitment to standardize volume history, changes in lung volume (ΔVL) were assessed at nasal CPAP of 8, 6, 4, and 0 cm H2O using calibrated direct current-coupled Respiratory Inductance Plethysmography. Results. ΔVL was significantly greater overall with the variable flow device compared with both the nasal cannula and CPAP prongs. However, ΔVL was not different between the cannula and the prongs. Respiratory rate, tidal volume, thoraco-abdominal asynchrony, and Fio2 were greater with the modified cannula than for either of the other 2 devices. Conclusion. Compared with 2 continuous flow devices, the variable flow nasal CPAP device leads to greater lung recruitment. Although a nasal cannula is able to recruit lung volume, it does so at the cost of increased Respiratory effort and Fio2.
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Respiratory Inductance Plethysmography rip for assessment of lung volume changes delta vl during high frequency oscillatory ventilation hfov dagger 1183
Pediatric Research, 1998Co-Authors: Kaye Weber, Sherry E Courtney, Kee H Pyon, Paresh B Pandit, Gordon Y Chang, Robert H HabibAbstract:A clinically applicable and reliable method to assess ΔVL in infants on HFOV could be of value to neonatologists when attempting to optimize gas exchange. We hypothesized that lung volume recruitment, ΔVL, could be accurately measured in both normal and saline-lavage induced RDS, using DC-coupled RIP. In five anesthetized, paralyzed and tracheostomized piglets(wt: 2-4 kg, age: 5-10 days), we compared estimates of ΔVL measured simultaneously by RIP and body Plethysmography (PL) before and after saline lung lavage. HFOV (SensorMedics 3100) settings were 8 Hz and pressure amplitudes of 50 pre- and 60 cmH2O post-lavage. Mean airway pressures (Paw) were varied between 6-14 and 10-26 cmH2O pre- and post-lavage respectively. Estimates of ΔVL from RIP and PL were in close agreement pre-and post-lavage, both: 1) during active recruitment (R=0.83-0.97; slope=0.76-1.16); and 2) at steady state (see example ΔVL @ Plateau, Figure). We conclude that RIP may have clinical application for determining optimal ΔVL during HFOV, thereby avoiding lung under- and over-distension.
Robert H Habib - One of the best experts on this subject based on the ideXlab platform.
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synchronized nasal intermittent positive pressure ventilation snippv decreases work of breathing wob in premature infants with Respiratory distress syndrome rds compared to nasal continuous positive airway pressure ncpap
Pediatric Pulmonology, 2006Co-Authors: Zubair H. Aghai, J G Saslow, Gary Stahl, Robert H Habib, Tarek Nakhla, Barry Milcarek, James Hart, Robyn Lawryshplunkett, Kee H PyonAbstract:Synchronized nasal intermittent positive pressure ventilation (SNIPPV) is non-invasive Respiratory support that delivers ventilator breaths via the nasal prongs. We hypothesized that SNIPPV is more effective than nasal continuous positive airway pressure (NCPAP) in premature neonates due to decreased work of breathing (WOB). Fifteen infants (BW: 1,367 +/- 325 g, GA: 29.5 +/- 2.4 weeks) were studied on (a) NCPAP at 5 cmH(2)O (NCPAP5) and (b) three increasing SNIPPV settings achieved by NCPAP5 with additional delivered peak inspiratory pressures (PIP) of 10, 12, and 14 cmH(2)O. Tidal volumes and transpulmonary pressures were estimated via calibrated Respiratory Inductance Plethysmography (RIP) and esophageal pressures, respectively. Inspiratory (WOB(insp)), resistive (RWOB), and elastic (WOB(E)) components of WOB were calculated using standard methods. Compared to NCPAP5, (a) WOB(insp) and RWOB were significantly lower with SNIPPV12, and were similarly lower with SNIPPV14 and (b) WOB(E) was significantly lower only with SNIPPV14. WOB components did not differ significantly for the three SNIPPV settings. Tidal volume, Respiratory rate (RR), minute ventilation, compliance, and phase angle were similar for all four measurements. In conclusion, compared to NCPAP, the addition of ventilator-delivered PIP during SNIPPV decreases WOB in premature infants.
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prone versus supine positioning in the well preterm infant effects on work of breathing and breathing patterns
Pediatric Pulmonology, 2006Co-Authors: Jennifer Levy, Robert H Habib, Ellina Liptsen, Andrew M Steele, Rachana Singh, Doron J Kahn, Sherry E CourtneyAbstract:Summary. Premature infants with Respiratory distress oxygenate better and have improved breathing synchrony when theyare nursed in the prone position. We investigated whether workof breathing(WOB)isdecreasedinthepronepositioninhealthyprematureinfantsnearingdischarge from the neonatal intensive care unit. Nineteen convalescing premature infants in room air were studied in both supine and prone position. Positioning order was randomized. Mean birth weight was1358 � 332(SD)g,gestationalage29.7 � 2.1weeks,weightatstudy1757 � 248g,andageat study 33.6 � 1.4 days. Calibrated Respiratory Inductance Plethysmography (RIP) was used to measuretidalvolume;anesophagealcatheterestimatedpleuralpressure.Inspiratory,elastic,and resistive WOB were calculated and were unaffected by proneversus supinepositioning(P ¼0.46, 0.36, and 0.87, respectively). Similarly, Respiratory rate, tidal volume, minute ventilation, and lung compliance did not differ between positions. These data suggest that sleep position recommendations for healthy premature infants discharged home without oxygen should be no different than for term infants. Pediatr Pulmonol. 2006; 41:754–758. 2006 Wiley-Liss, Inc.
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work of breathing during nasal continuous positive airway pressure in preterm infants a comparison of bubble vs variable flow devices
Journal of Perinatology, 2005Co-Authors: Ellina Liptsen, J G Saslow, Zubair H. Aghai, Kee H Pyon, Robert H Habib, Tarek Nakhla, Jennifer Long, Andrew M Steele, Sherry E CourtneyAbstract:To compare work of breathing and breathing asynchrony during bubble nasal continuous positive airway pressure (NCPAP) vs variable-flow (VF)-NCPAP in premature infants. We studied 18 premature infants of birth weight <1500 g who required NCPAP for mild Respiratory distress. Each infant was studied on bubble and VF-NCPAP at 8, 6, 4, and 0 cmH2O. Tidal volumes were obtained by calibrated Respiratory Inductance Plethysmography. Esophageal pressure estimated intrapleural pressure. Inspiratory and resistive work of breathing were calculated from pressure–volume data. Breathing asynchrony was assessed with phase angle. The results at all NCPAP levels were referenced to VF-NCPAP values at 8 cmH2O. Provision of NCPAP with either device decreased inspiratory work of breathing, tidal volume, and minute ventilation relative to NCPAP of 0 cmH2O. Bubble NCPAP did not decrease resistive work of breathing relative to 0 cmH2O. Resistive work of breathing (p=0.01), Respiratory rate (p<0.03), and phase angle (p=0.002) were all greater with bubble compared to VF-NCPAP. The more labored and asynchronous breathing seen with bubble NCPAP may lead to higher failure rates over the long term than with VF-NCPAP.
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lung recruitment and breathing pattern during variable versus continuous flow nasal continuous positive airway pressure in premature infants an evaluation of three devices
Pediatrics, 2001Co-Authors: Sherry E Courtney, J G Saslow, Kee H Pyon, Paresh B Pandit, Gerald K Arnold, Robert H HabibAbstract:Objective. To determine whether lung volume changes and breathing pattern parameters differ among 3 devices for delivery of nasal continuous positive airway pressure (CPAP) in premature infants. Methods. Thirty-two premature infants receiving nasal CPAP for apnea or mild Respiratory distress were enrolled. Birth weight was (mean ± standard deviation) 1081 ± 316 g, gestational age 29 ± 2 weeks, age at study 13 ± 12 days, and fraction of inspired oxygen (Fio2) at study .29 ± .1. Three devices, applied in random order, were studied in each infant: continuous flow nasal CPAP via CPAP prongs, continuous flow nasal CPAP via modified nasal cannula, and variable flow nasal CPAP. After lung recruitment to standardize volume history, changes in lung volume (ΔVL) were assessed at nasal CPAP of 8, 6, 4, and 0 cm H2O using calibrated direct current-coupled Respiratory Inductance Plethysmography. Results. ΔVL was significantly greater overall with the variable flow device compared with both the nasal cannula and CPAP prongs. However, ΔVL was not different between the cannula and the prongs. Respiratory rate, tidal volume, thoraco-abdominal asynchrony, and Fio2 were greater with the modified cannula than for either of the other 2 devices. Conclusion. Compared with 2 continuous flow devices, the variable flow nasal CPAP device leads to greater lung recruitment. Although a nasal cannula is able to recruit lung volume, it does so at the cost of increased Respiratory effort and Fio2.
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Respiratory Inductance Plethysmography rip for assessment of lung volume changes delta vl during high frequency oscillatory ventilation hfov dagger 1183
Pediatric Research, 1998Co-Authors: Kaye Weber, Sherry E Courtney, Kee H Pyon, Paresh B Pandit, Gordon Y Chang, Robert H HabibAbstract:A clinically applicable and reliable method to assess ΔVL in infants on HFOV could be of value to neonatologists when attempting to optimize gas exchange. We hypothesized that lung volume recruitment, ΔVL, could be accurately measured in both normal and saline-lavage induced RDS, using DC-coupled RIP. In five anesthetized, paralyzed and tracheostomized piglets(wt: 2-4 kg, age: 5-10 days), we compared estimates of ΔVL measured simultaneously by RIP and body Plethysmography (PL) before and after saline lung lavage. HFOV (SensorMedics 3100) settings were 8 Hz and pressure amplitudes of 50 pre- and 60 cmH2O post-lavage. Mean airway pressures (Paw) were varied between 6-14 and 10-26 cmH2O pre- and post-lavage respectively. Estimates of ΔVL from RIP and PL were in close agreement pre-and post-lavage, both: 1) during active recruitment (R=0.83-0.97; slope=0.76-1.16); and 2) at steady state (see example ΔVL @ Plateau, Figure). We conclude that RIP may have clinical application for determining optimal ΔVL during HFOV, thereby avoiding lung under- and over-distension.
Christopher J L Newth - One of the best experts on this subject based on the ideXlab platform.
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Respiratory Inductance Plethysmography calibration for pediatric upper airway obstruction: an animal model
2016Co-Authors: Robinder G Khemani, Patrick A Ross, Rutger Flink, Justin Hotz, Christopher J L NewthAbstract:Background—To determine optimal methods of Respiratory Inductance Plethysmography (RIP) flow calibration for application to pediatric post-extubation upper airway obstruction. Methods—We measured RIP, spirometry, and esophageal manometry in spontaneously breathing, intubated Rhesus monkeys with increasing inspiratory resistance. RIP calibration was based on: ΔµVao ≈ M[ΔµVRC + K(ΔµVAB)] where K establishes the relationship between the uncalibrated rib cage (ΔµVRC) and abdominal (ΔµVAB) RIP signals. We calculated K during: (1) isovolume maneuvers during a negative inspiratory force (NIF) (2) Quantitative Diagnostic Calibration (QDC) during (a) tidal breathing, (b) continuous positive airway pressure (CPAP), and (c) increasing degrees of UAO. We compared the calibrated RIP flow waveform to spirometry quantitatively and qualitatively. Results—Isovolume calibrated RIP flow tracings were more accurate (against spirometry) both quantitatively and qualitatively than those from QDC (p<0.0001), with bigger differences as UAO worsened. Isovolume calibration yielded nearly identical clinical interpretation of inspiratory flow limitation as spirometry
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evaluating risk factors for pediatric post extubation upper airway obstruction using a physiology based tool
American Journal of Respiratory and Critical Care Medicine, 2016Co-Authors: Patrick A Ross, Christopher J L Newth, Robinder G Khemani, Rutger Flink, Justin Hotz, Rica Morzov, Asavari KamerkarAbstract:Rationale: Subglottic edema is the most common cause of pediatric extubation failure, but few studies have confirmed risk factors or prevention strategies. This may be due to subjective assessment of stridor or inability to differentiate supraglottic from subglottic disease.Objectives: Objective 1 was to assess the utility of calibrated Respiratory Inductance Plethysmography (RIP) and esophageal manometry to identify clinically significant post-extubation upper airway obstruction (UAO) and differentiate subglottic from supraglottic UAO. Objective 2 was to identify risk factors for subglottic UAO, stratified by cuffed versus uncuffed endotracheal tubes (ETTs).Methods: We conducted a single-center prospective study of children receiving mechanical ventilation. UAO was defined by inspiratory flow limitation (measured by RIP and esophageal manometry) and classified as subglottic or supraglottic based on airway maneuver response. Clinicians performed simultaneous blinded clinical UAO assessment at the bedside....
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Respiratory Inductance Plethysmography calibration for pediatric upper airway obstruction an animal model
Pediatric Research, 2015Co-Authors: Robinder G Khemani, Patrick A Ross, Christopher J L Newth, Rutger Flink, Justin Hotz, Anoopindar GhumanAbstract:Respiratory Inductance Plethysmography calibration for pediatric upper airway obstruction: an animal model
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Respiratory Inductance Plethysmography used to diagnose bilateral diaphragmatic paralysis a case report
Pediatric Critical Care Medicine, 2004Co-Authors: Brigham C Willis, Alan S Graham, Randall C Wetzel, Christopher J L NewthAbstract:Objective To report the use of Respiratory Inductance Plethysmography in the diagnosis and management for a case of bilateral diaphragmatic paralysis after repeated sternotomies in a 23-month-old child. Design Case report. Setting A 15-bed pediatric cardiothoracic intensive care unit in an academic children's hospital. Interventions The patient could not be weaned from the ventilator after a repeat sternotomy for pulmonary artery reconstruction. Pulmonary function test results were within normal limits, and plain film radiography, ultrasonography, and fluoroscopy were unable to establish a definitive diagnosis. Evaluation of thoracoabdominal synchrony was undertaken using Respiratory Inductance Plethysmography (RespiTrace). The work of breathing was assessed using esophageal manometry to obtain the pressure-rate product. Results During spontaneous breathing, complete thoracoabdominal asynchrony was noted, with clockwise Konno-Mead loops and associated phase angles of nearly 180 degrees. The pressure-rate product was 120 cm H(2)O/min, indicating elevated work of breathing. The pressure-rate product decreased dramatically, as indicated by measurement and observation, in response to increased levels of continuous positive airway pressure. Conclusions The diagnosis of bilateral diaphragmatic paralysis can be confirmed by measurement of thoracoabdominal synchrony. Therapeutic and diagnostic application of continuous positive airway pressure may predict response to diaphragmatic plication. Controlled trials comparing measurement of thoracoabdominal synchrony with standard methods for the early diagnosis of diaphragmatic paralysis are needed.
Zubair H. Aghai - One of the best experts on this subject based on the ideXlab platform.
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a novel noninvasive approach for evaluating work of breathing indices in a developmental rat model using Respiratory Inductance Plethysmography
Scientific Reports, 2020Co-Authors: Yan Zhu, Zubair H. Aghai, Tariq Rahman, Suhita Gayen Nee Betal, Michael Favara, Gina Fong, Thomas H ShafferAbstract:Pulmonary function testing (PFT) is an important component for evaluating the outcome of experimental rodent models of Respiratory diseases. Respiratory Inductance Plethysmography (RIP) provides a noninvasive method of PFT requiring minimal cooperation. RIP measures work of breathing (WOB) indices including phase angle (Ф), percent rib cage (RC %), breaths per minute (BPM), and labored breathing index (LBI) on an iPad. The aim of this study was to evaluate the utility of a recently developed research instrument, pneuRIP, for evaluation of WOB indices in a developmental rat model. Sprague Dawley rats (2 months old) were commercially acquired and anaesthetised with isoflurane. The pneuRIP system uses two elastic bands: one band (RC) placed around the rib cage under the upper armpit and another band (AB) around the abdomen. The typical thoracoabdominal motion (TAM) plot showed the abdomen and rib cage motion in synchrony. The plots of phase angle and LBI as a function of data point number showed that values were within the range. The distribution for phase angle and LBI was within a narrow range. pneuRIP testing provided instantaneous PFT results. This study demonstrated the utility of RIP as a rapid, noninvasive approach for evaluating treatment interventions in the rodent model.
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synchronized nasal intermittent positive pressure ventilation snippv decreases work of breathing wob in premature infants with Respiratory distress syndrome rds compared to nasal continuous positive airway pressure ncpap
Pediatric Pulmonology, 2006Co-Authors: Zubair H. Aghai, J G Saslow, Gary Stahl, Robert H Habib, Tarek Nakhla, Barry Milcarek, James Hart, Robyn Lawryshplunkett, Kee H PyonAbstract:Synchronized nasal intermittent positive pressure ventilation (SNIPPV) is non-invasive Respiratory support that delivers ventilator breaths via the nasal prongs. We hypothesized that SNIPPV is more effective than nasal continuous positive airway pressure (NCPAP) in premature neonates due to decreased work of breathing (WOB). Fifteen infants (BW: 1,367 +/- 325 g, GA: 29.5 +/- 2.4 weeks) were studied on (a) NCPAP at 5 cmH(2)O (NCPAP5) and (b) three increasing SNIPPV settings achieved by NCPAP5 with additional delivered peak inspiratory pressures (PIP) of 10, 12, and 14 cmH(2)O. Tidal volumes and transpulmonary pressures were estimated via calibrated Respiratory Inductance Plethysmography (RIP) and esophageal pressures, respectively. Inspiratory (WOB(insp)), resistive (RWOB), and elastic (WOB(E)) components of WOB were calculated using standard methods. Compared to NCPAP5, (a) WOB(insp) and RWOB were significantly lower with SNIPPV12, and were similarly lower with SNIPPV14 and (b) WOB(E) was significantly lower only with SNIPPV14. WOB components did not differ significantly for the three SNIPPV settings. Tidal volume, Respiratory rate (RR), minute ventilation, compliance, and phase angle were similar for all four measurements. In conclusion, compared to NCPAP, the addition of ventilator-delivered PIP during SNIPPV decreases WOB in premature infants.
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work of breathing using high flow nasal cannula in preterm infants
Journal of Perinatology, 2006Co-Authors: J G Saslow, Zubair H. Aghai, T A Nakhla, J J Hart, R Lawrysh, Gary StahlAbstract:To compare the work of breathing (WOB) in premature neonates supported with high-flow nasal cannula (HFNC) and nasal continuous positive airway pressure (NCPAP). Eighteen preterm neonates <2.0 kg on HFNC or NCPAP support were studied in a random order. A ventilator was used to deliver 6 cm H2O of NCPAP with nasal prongs. High-flow nasal cannula delivered with Vapotherm (VAPO) at 3, 4 and 5 l/min was used. Tidal ventilation was obtained using Respiratory Inductance Plethysmography calibrated with face-mask pneumotachography. An esophageal balloon estimated pleural pressure from which changes in end distending pressure were calculated. Inspiratory, elastic and resistive WOB and Respiratory parameters were calculated. No differences were found in the WOB for all settings. Changes in end distending pressure did not vary significantly over all device settings except VAPO at 5 l/min. In these preterm infants with mild Respiratory illness, HFNC provided support comparable to NCPAP.
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work of breathing during nasal continuous positive airway pressure in preterm infants a comparison of bubble vs variable flow devices
Journal of Perinatology, 2005Co-Authors: Ellina Liptsen, J G Saslow, Zubair H. Aghai, Kee H Pyon, Robert H Habib, Tarek Nakhla, Jennifer Long, Andrew M Steele, Sherry E CourtneyAbstract:To compare work of breathing and breathing asynchrony during bubble nasal continuous positive airway pressure (NCPAP) vs variable-flow (VF)-NCPAP in premature infants. We studied 18 premature infants of birth weight <1500 g who required NCPAP for mild Respiratory distress. Each infant was studied on bubble and VF-NCPAP at 8, 6, 4, and 0 cmH2O. Tidal volumes were obtained by calibrated Respiratory Inductance Plethysmography. Esophageal pressure estimated intrapleural pressure. Inspiratory and resistive work of breathing were calculated from pressure–volume data. Breathing asynchrony was assessed with phase angle. The results at all NCPAP levels were referenced to VF-NCPAP values at 8 cmH2O. Provision of NCPAP with either device decreased inspiratory work of breathing, tidal volume, and minute ventilation relative to NCPAP of 0 cmH2O. Bubble NCPAP did not decrease resistive work of breathing relative to 0 cmH2O. Resistive work of breathing (p=0.01), Respiratory rate (p<0.03), and phase angle (p=0.002) were all greater with bubble compared to VF-NCPAP. The more labored and asynchronous breathing seen with bubble NCPAP may lead to higher failure rates over the long term than with VF-NCPAP.
J G Saslow - One of the best experts on this subject based on the ideXlab platform.
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synchronized nasal intermittent positive pressure ventilation snippv decreases work of breathing wob in premature infants with Respiratory distress syndrome rds compared to nasal continuous positive airway pressure ncpap
Pediatric Pulmonology, 2006Co-Authors: Zubair H. Aghai, J G Saslow, Gary Stahl, Robert H Habib, Tarek Nakhla, Barry Milcarek, James Hart, Robyn Lawryshplunkett, Kee H PyonAbstract:Synchronized nasal intermittent positive pressure ventilation (SNIPPV) is non-invasive Respiratory support that delivers ventilator breaths via the nasal prongs. We hypothesized that SNIPPV is more effective than nasal continuous positive airway pressure (NCPAP) in premature neonates due to decreased work of breathing (WOB). Fifteen infants (BW: 1,367 +/- 325 g, GA: 29.5 +/- 2.4 weeks) were studied on (a) NCPAP at 5 cmH(2)O (NCPAP5) and (b) three increasing SNIPPV settings achieved by NCPAP5 with additional delivered peak inspiratory pressures (PIP) of 10, 12, and 14 cmH(2)O. Tidal volumes and transpulmonary pressures were estimated via calibrated Respiratory Inductance Plethysmography (RIP) and esophageal pressures, respectively. Inspiratory (WOB(insp)), resistive (RWOB), and elastic (WOB(E)) components of WOB were calculated using standard methods. Compared to NCPAP5, (a) WOB(insp) and RWOB were significantly lower with SNIPPV12, and were similarly lower with SNIPPV14 and (b) WOB(E) was significantly lower only with SNIPPV14. WOB components did not differ significantly for the three SNIPPV settings. Tidal volume, Respiratory rate (RR), minute ventilation, compliance, and phase angle were similar for all four measurements. In conclusion, compared to NCPAP, the addition of ventilator-delivered PIP during SNIPPV decreases WOB in premature infants.
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work of breathing using high flow nasal cannula in preterm infants
Journal of Perinatology, 2006Co-Authors: J G Saslow, Zubair H. Aghai, T A Nakhla, J J Hart, R Lawrysh, Gary StahlAbstract:To compare the work of breathing (WOB) in premature neonates supported with high-flow nasal cannula (HFNC) and nasal continuous positive airway pressure (NCPAP). Eighteen preterm neonates <2.0 kg on HFNC or NCPAP support were studied in a random order. A ventilator was used to deliver 6 cm H2O of NCPAP with nasal prongs. High-flow nasal cannula delivered with Vapotherm (VAPO) at 3, 4 and 5 l/min was used. Tidal ventilation was obtained using Respiratory Inductance Plethysmography calibrated with face-mask pneumotachography. An esophageal balloon estimated pleural pressure from which changes in end distending pressure were calculated. Inspiratory, elastic and resistive WOB and Respiratory parameters were calculated. No differences were found in the WOB for all settings. Changes in end distending pressure did not vary significantly over all device settings except VAPO at 5 l/min. In these preterm infants with mild Respiratory illness, HFNC provided support comparable to NCPAP.
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work of breathing during nasal continuous positive airway pressure in preterm infants a comparison of bubble vs variable flow devices
Journal of Perinatology, 2005Co-Authors: Ellina Liptsen, J G Saslow, Zubair H. Aghai, Kee H Pyon, Robert H Habib, Tarek Nakhla, Jennifer Long, Andrew M Steele, Sherry E CourtneyAbstract:To compare work of breathing and breathing asynchrony during bubble nasal continuous positive airway pressure (NCPAP) vs variable-flow (VF)-NCPAP in premature infants. We studied 18 premature infants of birth weight <1500 g who required NCPAP for mild Respiratory distress. Each infant was studied on bubble and VF-NCPAP at 8, 6, 4, and 0 cmH2O. Tidal volumes were obtained by calibrated Respiratory Inductance Plethysmography. Esophageal pressure estimated intrapleural pressure. Inspiratory and resistive work of breathing were calculated from pressure–volume data. Breathing asynchrony was assessed with phase angle. The results at all NCPAP levels were referenced to VF-NCPAP values at 8 cmH2O. Provision of NCPAP with either device decreased inspiratory work of breathing, tidal volume, and minute ventilation relative to NCPAP of 0 cmH2O. Bubble NCPAP did not decrease resistive work of breathing relative to 0 cmH2O. Resistive work of breathing (p=0.01), Respiratory rate (p<0.03), and phase angle (p=0.002) were all greater with bubble compared to VF-NCPAP. The more labored and asynchronous breathing seen with bubble NCPAP may lead to higher failure rates over the long term than with VF-NCPAP.
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lung recruitment and breathing pattern during variable versus continuous flow nasal continuous positive airway pressure in premature infants an evaluation of three devices
Pediatrics, 2001Co-Authors: Sherry E Courtney, J G Saslow, Kee H Pyon, Paresh B Pandit, Gerald K Arnold, Robert H HabibAbstract:Objective. To determine whether lung volume changes and breathing pattern parameters differ among 3 devices for delivery of nasal continuous positive airway pressure (CPAP) in premature infants. Methods. Thirty-two premature infants receiving nasal CPAP for apnea or mild Respiratory distress were enrolled. Birth weight was (mean ± standard deviation) 1081 ± 316 g, gestational age 29 ± 2 weeks, age at study 13 ± 12 days, and fraction of inspired oxygen (Fio2) at study .29 ± .1. Three devices, applied in random order, were studied in each infant: continuous flow nasal CPAP via CPAP prongs, continuous flow nasal CPAP via modified nasal cannula, and variable flow nasal CPAP. After lung recruitment to standardize volume history, changes in lung volume (ΔVL) were assessed at nasal CPAP of 8, 6, 4, and 0 cm H2O using calibrated direct current-coupled Respiratory Inductance Plethysmography. Results. ΔVL was significantly greater overall with the variable flow device compared with both the nasal cannula and CPAP prongs. However, ΔVL was not different between the cannula and the prongs. Respiratory rate, tidal volume, thoraco-abdominal asynchrony, and Fio2 were greater with the modified cannula than for either of the other 2 devices. Conclusion. Compared with 2 continuous flow devices, the variable flow nasal CPAP device leads to greater lung recruitment. Although a nasal cannula is able to recruit lung volume, it does so at the cost of increased Respiratory effort and Fio2.