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Anne Greenough - One of the best experts on this subject based on the ideXlab platform.
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Work of Breathing during hhhfnc and synchronised nippv following extubation
European Journal of Pediatrics, 2019Co-Authors: Elinor Charles, Gerrard F Rafferty, Anne Greenough, Katie A Hunt, Janet L PeacockAbstract:Our aim was to compare the Work of Breathing (WOB) during synchronised nasal intermittent positive pressure ventilation (SNIPPV) and heated humidified high flow nasal cannula (HHHFNC) when used as post-extubation support in preterm infants. A randomised crossover study was undertaken of nine infants with a median gestational age of 27 (range 24–31) weeks and post-natal age of 7 (range 2–50) days. Infants were randomised to either SNIPPV or HHHFNC immediately following extubation. They were studied for 2 h on one mode and then switched to the other modality and studied for a further 2-h period. The Work of Breathing, assessed by measuring the pressure time product of the diaphragm (PTPdi), and thoracoabdominal asynchrony (TAA) were determined at the end of each 2-h period. The infants’ inspired oxygen requirement, oxygen saturation, heart rate and respiratory rate were also recorded. The median PTPdi was lower on SNIPPV than on HHHFNC (232 (range 130–352) versus 365 (range 136–449) cmH2O s/min, p = 0.0077), and there was less thoracoabdominal asynchrony (13.4 (range 8.5–41.6) versus 36.1 (range 4.3–50.4) degrees, p = 0.038). Conclusion: In prematurely born infants, SNIPPV compared to HHHFNC post-extubation reduced the Work of Breathing and thoracoabdominal asynchrony.
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volume targeting levels and Work of Breathing in infants with evolving or established bronchopulmonary dysplasia
Archives of Disease in Childhood-fetal and Neonatal Edition, 2019Co-Authors: Katie A Hunt, Theodore Dassios, Kamal Ali, Anne GreenoughAbstract:Objectives To assess the Work of Breathing at different levels of volume targeting in prematurely born infants with evolving or established bronchopulmonary dysplasia (BPD). Design Randomised crossover study. Setting Tertiary neonatal intensive care unit. Patients Eighteen infants born at Interventions Infants received ventilation at volume targeting levels of 4, 5, 6 and 7 mL/kg each for 20 minutes, the levels were delivered in random order. Baseline ventilation (without volume targeting) was delivered for 20 minutes between each epoch of volume-targeting. Main outcome measures Pressure-time product of the diaphragm (PTPdi), a measure of the Work of Breathing, at different levels of volume targeting. Results The 18 infants had a median gestational age of 26 (range 24–30) weeks and were studied at a median of 18 (range 7–60) days. The mean PTPdi was higher at 4 mL/kg than at baseline, 5 mL/kg, 6 mL/kg and 7 mL/kg (all P≤0.001). The mean PTPdi was higher at 5 mL/kg than at 6 mL/kg (P=0.008) and 7 mL/kg (P Conclusions Only a tidal volume target of 7 mL/kg reduced the Work of Breathing below the baseline and may be more appropriate for infants with evolving or established BPD who remained ventilator dependent at or beyond 7 days of age.
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Work of Breathing during cpap and heated humidified high flow nasal cannula
Archives of Disease in Childhood-fetal and Neonatal Edition, 2016Co-Authors: Sandeep Shetty, Gerrard F Rafferty, Janet L Peacock, Ann Hickey, Anne GreenoughAbstract:Objective To determine whether continuous positive airway pressure (CPAP) compared with heated humidified, high-flow nasal cannula (HHFNC) in infants with evolving or established bronchopulmonary dysplasia (BPD) reduced the Work of Breathing (WOB) and thoracoabdominal asynchrony (TAA) and improved oxygen saturation (SaO 2 ). Design Randomised crossover study. Setting Tertiary neonatal unit. Patients 20 infants (median gestational age of 27.6 weeks (range 24.6–31.9 weeks)) were studied at a median postnatal age of 30.9 weeks (range 28.1–39.1 weeks). Interventions Infants were studied on 2 consecutive days. On the first study day, they were randomised to either CPAP or HHFNC each for 2 h, the order being reversed on the second day. Main outcome measures The WOB was assessed by measuring the pressure time product of the diaphragm (PTPdi). PTPdi, TAA and SaO 2 were assessed during the final 5 min of each 2 h period and the results on the two study days were meaned. Results There were no significant differences in the results on CPAP versus HHFNC: mean PTPdi 226 (range 126–294) versus 224 cm H 2 O/s/min (95% CI for difference: −27 to 22; p=0.85) (range 170–318) (p=0.82), mean TAA 13.4° (range 4.51°–23.32°) versus 14.01° (range 4.25°–23.86°) (95% CI for difference: −3.9 to 2.8: p=0.73) (p=0.63) and mean SaO 2 95% (range 93%–100%) versus 95% (94%–99%), (95% CI for difference −1.8 to 0.5; p=0.25) (p=0.45). Conclusion In infants with evolving or established BPD, CPAP compared with HHFNC offered no significant advantage with regard to the WOB, degree of asynchrony or oxygen saturation.
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in vitro assessment of the effect of proportional assist ventilation on the Work of Breathing
European Journal of Pediatrics, 2016Co-Authors: Olie Chowdhury, Gerrard F Rafferty, Anne Greenough, Simon Hannam, Prashanth Bhat, Anthony D MilnerAbstract:During proportional assist ventilation, elastic and resistive unloading can be delivered to reduce the Work of Breathing (WOB). Our aim was to determine the effects of different levels of elastic and resistive unloading on the WOB in lung models designed to mimic certain neonatal respiratory disorders. Two dynamic lung models were used, one with a compliance of 0.4 ml/cm H2O to mimic an infant with respiratory distress syndrome and one with a resistance of 300 cm H2O/l/s to mimic an infant with bronchopulmonary dypslasia. Pressure volume curves were constructed at each unloading level. Elastic unloading in the low compliance model was highly effective in reducing the WOB measured in the lung model; the effective compliance increased from 0.4 ml/cm H2O at baseline to 4.1 ml/cm H2O at maximum possible elastic unloading (2.0 cm H2O/ml). Maximum possible resistive unloading (200 cm H2O/l/s) in the high-resistance model only reduced the effective resistance from 300 to 204 cm H2O/l/s. At maximum resistive unloading, oscillations appeared in the airway pressure waveform.
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Work of Breathing and volume targeted ventilation in respiratory distress
Archives of Disease in Childhood-fetal and Neonatal Edition, 2010Co-Authors: Deenashefali Patel, Gerrard F Rafferty, Silke Lee, Simon Hannam, Anne GreenoughAbstract:Objective To determine the level of volume targeting (VT) associated with the lowest Work of Breathing (WOB) for prematurely born infants being ventilated with acute respiratory distress. Design Prospective study. Setting Tertiary neonatal intensive care unit. Patients 18 infants, median gestational age 29 (range 25–34) weeks, being ventilated for acute respiratory distress. Interventions Infants were studied first without VT (baseline). Volume targeted levels of 4 ml/kg, 5 ml/kg and 6 ml/kg were then delivered in random order. After each VT level, the infants were returned to baseline. Each step was maintained for 20 minutes. Main outcome measure The transdiaphragmatic pressure time product (PTPdi) as an estimate of the WOB. Results The mean PTPdi was higher at a VT level of 4 ml/kg (median 154 cm H2O·s/min) compared to baseline (median 112 cm H2O·s/min) (p<0.001) and a VT level of 6 ml/kg (median 89 cm H2O·s/min) (p<0.001). Conclusion A low level of VT increased the WOB in infants with acute respiratory distress syndrome. The authors' results suggest that, during acute respiratory distress, a VT level of at least 5 ml/kg rather than a lower level might avoid an increased WOB. The most appropriate level of VT needs to be determined in a randomised controlled trial with long-term outcomes.
Brigitte Fauroux - One of the best experts on this subject based on the ideXlab platform.
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effect of the measurement of the Work of Breathing on the respiratory outcome of preterms
Journal of Maternal-fetal & Neonatal Medicine, 2021Co-Authors: Benjamin Dudoignon, Sonia Khirani, Alessandro Amaddeo, Rafik Ben Ammar, Daniele De Luca, Heloise Torchin, Alexandre Lapillonne, Pierrehenri Jarreau, Brigitte FaurouxAbstract:There are no validated criteria for the choice of the optimal type of noninvasive respiratory support (NRS) and most appropriate settings in preterms.The Work of Breathing (WOB) during oxygen (O2) ...
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continuous positive airway pressure improves Work of Breathing in pediatric chronic heart failure
Sleep Medicine, 2021Co-Authors: Brigitte Fauroux, Sonia Khirani, Alessandro Amaddeo, Diala Khraiche, Mathilde Meot, Jeanphilippe Jais, Damien BonnetAbstract:Abstract Background Sleep disordered Breathing (SDB) is common in adults with chronic heart failure (CHF), but its prevalence in children remains unclear. Continuous positive airway pressure (CPAP) is the treatment of SDB but deleterious hemodynamic effects have been reported. Methods We prospectively analyzed SDB in children with CHF and the effect of CPAP on Work of Breathing (WOB) and cardiac index (CI). Children aged 6 months to 18 years old with CHF due to: 1) dilated cardiomyopathy (DM) with an ejection fraction Results Thirty patients with mean age of 6.4 ± 5 years were included (16 DM 16, 10 SV, 4 LV). Twenty (73%) patients had a normal sleep efficiency. Median apnoeas hypopnea index (IAH) was within normal range at 1.6 events/h (0, 14) events/hour. Only one patient had central sleep apnoeas, none had Cheyne-Stokes respiration, and 3 patients had an obstructive AHI between 5 and 10 events/hour. Optimal CPAP level decreased WOB (p = 0.05) and respiratory rate (p = 0.01). Conclusions Severe SDB was uncommon in children with CHF. However, CPAP may be beneficial by decreasing WOB and respiratory rate without deleterious effects on CI.
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Impact of Spontaneous Breathing Trial on Work of Breathing Indices Derived From Esophageal Pressure, Electrical Activity of the Diaphragm, and Oxygen Consumption in Children.
Respiratory care, 2018Co-Authors: Guillaume Mortamet, Nicolas Nardi, Véronique Groleau, Sandrine Essouri, Brigitte Fauroux, Philippe Jouvet, Guillaume EmeriaudAbstract:BACKGROUND: The present study aimed to characterize the behavior of 3 components of respiratory muscle function during mechanical ventilation weaning in children to better understand the respective impact of a spontaneous Breathing trial on ventilatory mechanical action (esophageal pressure [P es ], ventilatory demand (electrical activity of the diaphragm [EA di ]), and oxygen consumption. METHODS: This was a prospective single-center study. All children > 1 months and es , and EA di were performed during 3 steps: before, during, and after the spontaneous Breathing test. RESULTS: Twenty subjects (median age, 5.5 mo) were included. Half of them were admitted for a respiratory cause. The increase in P es swings and esophageal pressure-time product during the spontaneous Breathing trial was not significant ( P = .33 and P = .75, respectively), and a similar trend was observed with peak EA di ( P = .06). Oxygen consumption obtained by indirect calorimetry was stable in the 3 conditions ( P = .98). CONCLUSIONS: In these children who were critically ill, a spontaneous Breathing trial induced a moderate and nonsignificant increase in Work of Breathing, as reflected by the respiratory drive with EA di and respiratory mechanics with P es . However, indirect calorimetry did not seem to be a sensitive tool to assess respiratory muscle function during the weaning phase in children who were on mechanical ventilation, especially when Work of Breathing was slightly increased.
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Work of Breathing in children with diffuse parenchymal lung disease
Respiratory Physiology & Neurobiology, 2015Co-Authors: Brigitte Fauroux, Sonia Khirani, Adriana Ramirez, Nadia Nathan, Sabrina Aloui, Christophe Delacourt, Annick ClementAbstract:Abstract Respiratory mechanics have been poorly studied in children with chronic diffuse parenchymal lung disease (DPLD). The aim of the study was to assess the usefulness of respiratory mechanics to monitor lung function alteration in children with DPLD. Respiratory mechanics, total (WOBt), elastic (WOBe) and resistive (WOBr) Work of Breathing, gas exchange, lung function and respiratory muscle strength were measured in 10 children, aged 1.8–18.4 years old, who were followed in our national reference centre. Mean tidal volume (V t ) was normal (11 ± 4 mL/kg) but respiratory rate (f r , 32 ± 19 breaths/min), f r /V t (118 ± 75 breaths/min/L) and total lung resistance (10.2 ± 4.8 cm H 2 O L −1 s) were increased. Mean WOBt was increased mainly due to WOBe. Dynamic lung compliance (C l dyn) was severely reduced (26 ± 24 mL/cm H 2 O). C l dyn and the oesophageal pressure-time product strongly correlated with vital capacity and functional residual capacity. Respiratory muscle strength was within the normal range. In conclusion, lung mechanics may be considered as useful complementary or alternative markers of functional abnormalities in children with DPLD.
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Work of Breathing as a tool to diagnose severe fixed upper airway obstruction
Pediatric Pulmonology, 2014Co-Authors: Sonia Khirani, Brigitte Fauroux, S Pierrot, Nicolas Leboulanger, Adriana Ramirez, D Breton, V CouloignerAbstract:A 4-year-old girl with bilateral vocal fold palsy was successfully decannulated from tracheotomy after seven laryngeal procedures. But an important stridor and dyspnea recurred 13 months after decannulation. Nocturnal gas exchange was normal but her daytime Work of Breathing was increased by fourfold, without any beneficial effect of nasal noninvasive continuous positive airway pressure ventilation (CPAP), reflecting a severe fixed airway obstruction. Endoscopic examination confirmed the Work of Breathing findings showing glottic and supraglottic stenosis. This upper airway obstruction was successfully treated with a recannulation. In conclusion, the major message of this case report is that measurement of the Work of Breathing was able to document the "fixed" nature of the airway obstruction, by showing no improvement even with highest tolerated levels of nasal CPAP. As such, the Work of Breathing may be proposed as a screening tool to quantify and assess the reversibility of severe upper airway obstruction in children.
Luigi Camporota - One of the best experts on this subject based on the ideXlab platform.
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assessment of Work of Breathing in patients with acute exacerbations of chronic obstructive pulmonary disease
COPD: Journal of Chronic Obstructive Pulmonary Disease, 2019Co-Authors: Luigi Camporota, Nicholas A Barrett, Nicholas HartAbstract:The assessment of the Work of Breathing (WOB) of patients with acute exacerbations of chronic obstructive pulmonary disease (COPD) is difficult, particularly when the patient first presents with acute hypercapnia and respiratory acidosis. Acute exacerbations of COPD patients are in significant respiratory distress and noninvasive measurements of WOB are easier for the patient to tolerate. Given the interest in using alternative therapies to noninvasive ventilation, such as high flow nasal oxygen therapy or extracorporeal carbon dioxide removal, understanding the physiological changes are key and this includes assessment of WOB. This narrative review considers the role of three different methods of assessing WOB in patients with acute exacerbations of COPD. Esophageal pressure is a very well validated measure of WOB, however the ability of patients with acute exacerbations of COPD to tolerate esophageal tubes is poor. Noninvasive alternative measurements include parasternal electromyography (EMG) and electrical impedance tomography (EIT). EMG is easily applied and is a well validated measure of neural drive but is more likely to be degraded by the electrical environment in intensive care or high dependency. EIT is less well validated as a tool for WOB in COPD but extremely well tolerated by patients. Each of the different methods assess WOB in a different way and have different advantages and disadvantages. For research into therapies treating acute exacerbations of COPD, combinations of EIT, EMG and esophageal pressure are likely to be better than only one of these.
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high flow nasal cannula oxygen therapy decreases postextubation neuroventilatory drive and Work of Breathing in patients with chronic obstructive pulmonary disease
Critical Care, 2018Co-Authors: Rosa Di Mussi, Savino Spadaro, Tania Stripoli, Carlo Alberto Volta, Paolo Trerotoli, Paola Pierucci, Francesco Staffieri, Francesco Bruno, Luigi Camporota, Salvatore GrassoAbstract:The physiological effects of high-flow nasal cannula O2 therapy (HFNC) have been evaluated mainly in patients with hypoxemic respiratory failure. In this study, we compared the effects of HFNC and conventional low-flow O2 therapy on the neuroventilatory drive and Work of Breathing postextubation in patients with a background of chronic obstructive pulmonary disease (COPD) who had received mechanical ventilation for hypercapnic respiratory failure. This was a single center, unblinded, cross-over study on 14 postextubation COPD patients who were recovering from an episode of acute hypercapnic respiratory failure of various etiologies. After extubation, each patient received two 1-h periods of HFNC (HFNC1 and HFNC2) alternated with 1 h of conventional low-flow O2 therapy via a face mask. The inspiratory fraction of oxygen was titrated to achieve an arterial O2 saturation target of 88–92%. Gas exchange, Breathing pattern, neuroventilatory drive (electrical diaphragmatic activity (EAdi)) and Work of Breathing (inspiratory trans-diaphragmatic pressure-time product per minute (PTPDI/min)) were recorded. EAdi peak increased from a mean (±SD) of 15.4 ± 6.4 to 23.6 ± 10.5 μV switching from HFNC1 to conventional O2, and then returned to 15.2 ± 6.4 μV during HFNC2 (conventional O2: p < 0.05 versus HFNC1 and HFNC2). Similarly, the PTPDI/min increased from 135 ± 60 to 211 ± 70 cmH2O/s/min, and then decreased again during HFNC2 to 132 ± 56 (conventional O2: p < 0.05 versus HFNC1 and HFNC2). In patients with COPD, the application of HFNC postextubation significantly decreased the neuroventilatory drive and Work of Breathing compared with conventional O2 therapy.
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high flow nasal cannula oxygen therapy decreases postextubation neuroventilatory drive and Work of Breathing in patients with chronic obstructive pulmonary disease
Critical Care, 2018Co-Authors: Rosa Di Mussi, Savino Spadaro, Tania Stripoli, Carlo Alberto Volta, Paolo Trerotoli, Paola Pierucci, Francesco Staffieri, Francesco Bruno, Luigi Camporota, Salvatore GrassoAbstract:The physiological effects of high-flow nasal cannula O2 therapy (HFNC) have been evaluated mainly in patients with hypoxemic respiratory failure. In this study, we compared the effects of HFNC and conventional low-flow O2 therapy on the neuroventilatory drive and Work of Breathing postextubation in patients with a background of chronic obstructive pulmonary disease (COPD) who had received mechanical ventilation for hypercapnic respiratory failure. This was a single center, unblinded, cross-over study on 14 postextubation COPD patients who were recovering from an episode of acute hypercapnic respiratory failure of various etiologies. After extubation, each patient received two 1-h periods of HFNC (HFNC1 and HFNC2) alternated with 1 h of conventional low-flow O2 therapy via a face mask. The inspiratory fraction of oxygen was titrated to achieve an arterial O2 saturation target of 88–92%. Gas exchange, Breathing pattern, neuroventilatory drive (electrical diaphragmatic activity (EAdi)) and Work of Breathing (inspiratory trans-diaphragmatic pressure-time product per minute (PTPDI/min)) were recorded. EAdi peak increased from a mean (±SD) of 15.4 ± 6.4 to 23.6 ± 10.5 μV switching from HFNC1 to conventional O2, and then returned to 15.2 ± 6.4 μV during HFNC2 (conventional O2: p < 0.05 versus HFNC1 and HFNC2). Similarly, the PTPDI/min increased from 135 ± 60 to 211 ± 70 cmH2O/s/min, and then decreased again during HFNC2 to 132 ± 56 (conventional O2: p < 0.05 versus HFNC1 and HFNC2). In patients with COPD, the application of HFNC postextubation significantly decreased the neuroventilatory drive and Work of Breathing compared with conventional O2 therapy.
J G Saslow - One of the best experts on this subject based on the ideXlab platform.
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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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Work of Breathing during constant and variable flow nasal continuous positive airway pressure in preterm neonates
Pediatrics, 2001Co-Authors: Paresh B Pandit, J G Saslow, Sherry E Courtney, Kee H Pyon, Robert H HabibAbstract:Background. Constant-flow nasal con- tinuous positive airway pressure (NCPAP) often is used in preterm neonates to recruit and maintain lung volume. Physical model studies indicate that a variable-flow NC- PAP device provides more stable volume recruitment with less imposed Work of Breathing (WOB). Although superior lung recruitment with variable-flow NCPAP has been demonstrated in preterm neonates, corroborating WOB data are lacking. Objective. To measure and compare WOB associated with the use of variable-flow versus constant-flow NCPAP in preterm neonates. Methods. Twenty-four preterm infants who were re- ceiving constant-flow NCPAP (means, SD) and had birth weight of 1024 6 253 g, gestational age of 28 6 1.7 weeks, age of 14 6 13 days, and FIO2 of 0.3 6 0.1 were studied. Variable-flow and constant-flow NCPAP were applied in random order. We measured changes in lung volume and tidal ventilation (VT) by DC-coupled/calibrated respira- tory inductance plethysmography as well as esophageal pressures at NCPAP of 8, 6, 4, and 0 cm H2O. Inspiratory WOB (WOBI) and lung compliance were calculated from the esophageal pressure and VT data using standard meth- ods. WOB was divided by VT to standardize the results. Results. WOBI decreased at all CPAP levels with variable-flow NCPAP, with a maximal decrease at 4 cm H2O. WOBI increased at all CPAP levels with constant- flow CPAP. Lung compliance increased at all NCPAP levels with variable-flow, with a relative decrease at 8 cm H2O, whereas it increased only at 8 cm H2O with constant-flow NCPAP. Compared with constant-flow NCPAP, WOBI was 13% to 29% lower with variable-flow NCPAP. Conclusion. WOBI is decreased with variable-flow NCPAP compared with constant-flow NCPAP. The in- crease in WOBI with constant-flow NCPAP indicates the presence of appreciable imposed WOB with this device. Our study, performed in neonates with little lung dis- ease, indicates the possibility of lung overdistention at CPAP of 6 to 8 cm H2O with the variable-flow device. Further study is necessary to determine the efficacy of variable-flow NCPAP in neonates with significant lung disease and its use over extended periods of time. Pediatrics 2001;108:682- 685; continuous-flow and vari- able-flow NCPAP, Work of Breathing, premature neonates, lung compliance.
Gary Stahl - One of the best experts on this subject based on the ideXlab platform.
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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.
