Feasibility of assessing ventilation inhomogeneity by volumetric capnography during resuscitation of preterm infants

2021 ◽  
Author(s):  
Emma Williams ◽  
Theodore Dassios ◽  
Anne Greenough
Keyword(s):  
Preterm Infants ◽  
Volumetric Capnography ◽  
Ventilation Inhomogeneity

scholarly journals Volumetric capnography pre- and post-surfactant during initial resuscitation of premature infants

2021 ◽  
Author(s):  
Emma E. Williams ◽  
Theodore Dassios ◽  
Katie A. Hunt ◽  
Anne Greenough
Keyword(s):  
Tidal Volume ◽  
Preterm Infants ◽  
Respiratory Function ◽  
Continuous Monitoring ◽  
List Type ◽  
Volumetric Capnography ◽  
Alveolar Plateau ◽  
Initial Resuscitation ◽  
Ventilation Inhomogeneity ◽  
Surfactant Administration

Abstract Background Volumetric capnography allows for continuous monitoring of expired tidal volume and carbon dioxide. The slope of the alveolar plateau of the capnogram (SIII) could provide information regarding ventilation homogeneity. We aimed to assess the feasibility of measuring SIII during newborn resuscitation and determine if SIII decreased after surfactant indicating ventilation inhomogeneity improvement. Methods Respiratory function traces of preterm infants resuscitated at birth were analysed. Ten capnograms were constructed for each infant: five pre- and post-surfactant. If a plateau was present SIII was calculated by regression analysis. Results Thirty-six infants were included, median gestational age of 28.7 weeks and birth weight of 1055 g. Average time between pre- and post-surfactant was 3.2 min. Three hundred and sixty capnograms (180 pre and post) were evaluated. There was adequate slope in 134 (74.4%) capnograms pre and in 100 (55.6%) capnograms post-surfactant (p = 0.004). Normalised for tidal volume SIII pre-surfactant was 18.89 mmHg and post-surfactant was 24.86 mmHg (p = 0.006). An increase in SIII produced an up-slanting appearance to the plateau indicating regional obstruction. Conclusion It was feasible to evaluate the alveolar plateau pre-surfactant in preterm infants. Ventilation inhomogeneity increased post-surfactant likely due to airway obstruction caused by liquid surfactant present in the airways. Impact Volumetric capnography can be used to assess homogeneity of ventilation by SIII analysis. Ventilation inhomogeneity increased immediately post-surfactant administration during the resuscitation of preterm infants, producing a characteristic up-slanting appearance to the alveolar plateau. The best determinant of alveolar plateau presence in preterm infants was the expired tidal volume.

Volumetric capnography slopes in ventilated term and preterm infants

2020 ◽  
Vol 41 (5) ◽  
pp. 055001
Author(s):  
Theodore Dassios ◽  
Paul Dixon ◽  
Emma Williams ◽  
Anne Greenough
Keyword(s):  
Preterm Infants ◽  
Volumetric Capnography

scholarly journals Regional ventilation characteristics during non-invasive respiratory support in preterm infants

2020 ◽  
pp. fetalneonatal-2020-320449
Author(s):  
Jessica Thomson ◽  
Christoph M Rüegger ◽  
Elizabeth J Perkins ◽  
Prue M Pereira-Fantini ◽  
Olivia Farrell ◽  
...  
Keyword(s):  
Oxygen Saturation ◽  
Preterm Infants ◽  
Neonatal Intensive Care ◽  
Repeated Measure ◽  
Regional Ventilation ◽  
Quiet Breathing ◽  
Impedance Tomography ◽  
Non Invasive ◽  
Ventilation Inhomogeneity ◽  
The Right

ObjectivesTo determine the regional ventilation characteristics during non-invasive ventilation (NIV) in stable preterm infants. The secondary aim was to explore the relationship between indicators of ventilation homogeneity and other clinical measures of respiratory status.DesignProspective observational study.SettingTwo tertiary neonatal intensive care units.PatientsForty stable preterm infants born <30 weeks of gestation receiving either continuous positive airway pressure (n=32) or high-flow nasal cannulae (n=8) at least 24 hours after extubation at time of study.InterventionsContinuous electrical impedance tomography imaging of regional ventilation during 60 min of quiet breathing on clinician-determined non-invasive settings.Main outcome measuresGravity-dependent and right–left centre of ventilation (CoV), percentage of whole lung tidal volume (VT) by lung region and percentage of lung unventilated were determined for 120 artefact-free breaths/infant (4770 breaths included). Oxygen saturation, heart and respiratory rates were also measured.ResultsVentilation was greater in the right lung (mean 69.1 (SD 14.9)%) total VT and the gravity-non-dependent (ND) lung; ideal–actual CoV 1.4 (4.5)%. The central third of the lung received the most VT, followed by the non-dependent and dependent regions (p<0.0001 repeated-measure analysis of variance). Ventilation inhomogeneity was associated with worse peripheral capillary oxygen saturation (SpO2)/fraction of inspired oxygen (FiO2) (p=0.031, r2 0.12; linear regression). In those infants that later developed bronchopulmonary dysplasia (n=25), SpO2/FiO2 was worse and non-dependent ventilation inhomogeneity was greater than in those that did not (both p<0.05, t-test Welch correction).ConclusionsThere is high breath-by-breath variability in regional ventilation patterns during NIV in preterm infants. Ventilation favoured the ND lung, with ventilation inhomogeneity associated with worse oxygenation.

Lung Volume and Ventilation Inhomogeneity in Preterm Infants at 15-18 Months Corrected Age

2010 ◽  
Vol 156 (4) ◽  
pp. 542-549.e2 ◽  
Author(s):  
Sven M. Schulzke ◽  
Graham L. Hall ◽  
Elizabeth A. Nathan ◽  
Karen Simmer ◽  
Gary Nolan ◽  
...  
Keyword(s):  
Preterm Infants ◽  
Lung Volume ◽  
Ventilation Inhomogeneity

scholarly journals Volumetric capnography to detect ventilation inhomogeneity in children and adolescents with controlled persistent asthma

2011 ◽  
Vol 87 (2) ◽  
pp. 163-168 ◽  
Author(s):  
Celize C.B. Almeida ◽  
Armando A. Almeida-Júnior ◽  
Maria &Acirc;ngela G. O. Ribeiro ◽  
Marcos T. Nolasco-Silva ◽  
José Dirceu Ribeiro
Keyword(s):  
Children And Adolescents ◽  
Persistent Asthma ◽  
Volumetric Capnography ◽  
Ventilation Inhomogeneity

scholarly journals Regional ventilation characteristics during non-invasive respiratory support in preterm infants

2020 ◽  
Author(s):  
J Thomson ◽  
CM Rueegger ◽  
EJ Perkins ◽  
PM Pereira-Fantini ◽  
O Farrell ◽  
...  
Keyword(s):  
Tidal Volume ◽  
Preterm Infants ◽  
Applied Pressure ◽  
Repeated Measure ◽  
Regional Ventilation ◽  
Quiet Breathing ◽  
Impedance Tomography ◽  
Non Invasive ◽  
Ventilation Inhomogeneity ◽  
Nondependent Lung

ABSTRACTObjectiveTo determine the regional ventilation characteristics during non-invasive ventilation in stable preterm infants. The secondary aims were to explore the relationship between indicators of ventilation homogeneity and other clinical measures of respiratory status.DesignProspective observational study.SettingTwo tertiary neonatal intensive care units.PatientsForty stable preterm infants born <30 weeks gestation receiving either continuous positive applied pressure (n=32) or nasal high-flow cannualae (n=8) at least 24 hours after extubation at time of study.InterventionsContinuous electrical impedance tomography imaging of regional ventilation during 60-minutes of quiet breathing on clinician-determined non-invasive settings.Main outcome measuresGravity-dependent and right-left centre of ventilation (CoV), percentage of whole lung tidal volume by lung region, and percentage of lung unventilated were determined for 120 artefact-free breaths/infant (4770 breaths included). Oxygen saturation, heart and respiratory rates were also measured.ResultsVentilation was greater in the right lung (mean (SD) 69.1 (14.9)%) total tidal volume and the gravity-nondependent lung; ideal-actual CoV 1.4 (4.5)%. The central third of the lung received the most tidal volume, followed by the non-dependent and dependent regions (p<0.0001 repeated measure ANOVA). Ventilation inhomogeneity was associated with worse SpO2/FiO2, (p=0.031, r2 0.12; linear regression). In those infants that later developed bronchopulmonary dysplasia (n=25) SpO2/FiO2 was worse and non-dependent ventilation inhomogeneity greater than in those that did not (both p<0.05; t test Welch correction).ConclusionsThere is high breath-by-breath variability in regional ventilation patterns during NIV in preterm infants. Ventilation favoured the gravity-nondependent lung, with ventilation inhomogeneity associated with worse oxygenation.

scholarly journals Novel volumetric capnography indices measure ventilation inhomogeneity in cystic fibrosis

2022 ◽  
pp. 00440-2021
Author(s):  
Sotirios Fouzas ◽  
Anne-Christianne Kentgens ◽  
Olga Lagiou ◽  
Bettina Sarah Frauchiger ◽  
Florian Wyler ◽  
...  
Keyword(s):  
Cystic Fibrosis ◽  
Diagnostic Performance ◽  
Relative Difference ◽  
Lung Model ◽  
Discriminative Ability ◽  
Volumetric Capnography ◽  
Ventilation Inhomogeneity ◽  
Diagnostic Characteristics ◽  
Multiple Breath Washout ◽  
Better Than

BackgroundVolumetric capnography (VCap) is a simpler alternative of multiple-breath washout (MBW) to detect ventilation inhomogeneity (VI) in patients with cystic fibrosis (CF). However, its diagnostic performance is influenced by breathing dynamics. We introduce two novel VCap indices, the Capnographic Inhomogeneity Indices (CIIs) that may overcome this limitation and explore their diagnostic characteristics in a cohort of CF patients.MethodsWe analysed 320 N2-MBW trials from 50 CF patients and 65 controls (age 4-18 years) and calculated classical VCap indices, such as slope III (SIII) and the capnographic index (KPIv). We introduced novel CIIs based on a theoretical lung model, and assessed their diagnostic performance compared to classical VCap indices and the lung clearance index (LCI).ResultsBoth CIIs were significantly higher in CF patients compared with controls (mean±SD CII1 5.9±1.4% versus 5.1±1.0%, p=0.002; CII2 7.7±1.8% versus 6.8±1.4%, p=0.002) and presented strong correlation with LCI (CII1 R2=0.47 and CII2 R2=0.44 in CF patients). Classical VCap indices showed inferior discriminative ability (SIII 2.3±1.0%/L versus 1.9±0.7%/L, P=0.013; KPIv 3.9±1.3% versus 3.5±1.2%, P=0.071), while the correlation with LCI was weak (SIII R2=0.03; KPIv R2=0.08 in CF patients). CIIs showed lower intra-subject inter-trial variability, calculated as coefficient of variation for three and relative difference for two trials, than classical VCap indices, but higher than LCI (CII1 11.1±8.2% and CII2 11.0±8.0% versus SIII 16.3±13.5%; KPIv 15.9±12.8%; LCI 5.9%±4.2%).ConclusionCIIs detect VI better than classical VCap indices and correlate well with LCI. However, further studies on their diagnostic performance and clinical utility are required.

Auditory Arousal in Preterm Infants

1984 ◽  
Vol 11 ◽  
pp. 3-9 ◽  
Author(s):  
Kay Lynn Copriviza ◽  
Cynthia Gayle Lima
Keyword(s):  
Preterm Infants
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