The Effect of Posture on Ventilation and Lung Mechanics in Preterm and Light-for-Date Infants

PEDIATRICS ◽  
1979 ◽  
Vol 64 (4) ◽  
pp. 429-432 ◽  
Author(s):  
Alastair A. Hutchison ◽  
Keith R. Ross ◽  
George Russell
Keyword(s):  
Tidal Volume ◽  
Prone Position ◽  
Supine Position ◽  
Work Of Breathing ◽  
Newborn Infants ◽  
Lateral Position ◽  
Minute Volume ◽  
Lung Mechanics ◽  
Total Work ◽  
Preterm Group

The effect of right lateral, supine, and prone postures on ventilation and lung mechanics was studied in 23 healthy newborn infants, ten preterm and 13 term, "light-for-date." In the preterm group, tidal volume, minute volume, elastic work, inspiratory viscous work, total viscous work, and the total work of breathing were significantly greater in the prone position than in the supine position. Results obtained in the lateral position did not differ significantly from those in the prone or supine positions. Posture did not significantly affect tidal volume or lung mechanics in the light-for-date infants. The prone position is suggested to be the optimum nursing posture for healthy preterm infants.

RESPIRATORY RATE, TIDAL VOLUME AND VENTILATION OF NEWBORN INFANTS IN THE PRONE AND SUPINE POSITIONS

PEDIATRICS ◽  
1961 ◽  
Vol 28 (3) ◽  
pp. 388-393
Author(s):  
W. T. Bruns ◽  
K. O. Loken ◽  
A. A. Siebens
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
Tidal Volume ◽  
Respiratory Rate ◽  
Prone Position ◽  
Congenital Heart ◽  
Newborn Infants ◽  
Periodic Breathing ◽  
Continuous Recording ◽  
Body Plethysmograph

The respiratory rate, tidal volume and ventilation were measured in newborn infants with a body plethysmograph. A continuous recording revealed that, with one exception, no significant change occurred in these parameters when seven mature infants were turned from supine to prone position or vice versa. Two mature infants with periodic breathing, one of whom had congenital heart disease, exhibited periods of apnea when placed from the supine into the prone position.

scholarly journals Determinants of the esophageal-pleural pressure relationship in humans

2020 ◽  
Vol 128 (1) ◽  
pp. 78-86 ◽  
Author(s):  
Iacopo Pasticci ◽  
Paolo Cadringher ◽  
Lorenzo Giosa ◽  
Michele Umbrello ◽  
Paolo Formenti ◽  
...  
Keyword(s):  
Tidal Volume ◽  
Chest Wall ◽  
Supine Position ◽  
Body Position ◽  
Esophageal Pressure ◽  
Lateral Position ◽  
Pleural Pressure ◽  
Absolute Value ◽  
Gravitational Forces ◽  
Chest Wall Elastance

Esophageal pressure has been suggested as adequate surrogate of the pleural pressure. We investigate after lung surgery the determinants of the esophageal and intrathoracic pressures and their differences. The esophageal pressure (through esophageal balloon) and the intrathoracic/pleural pressure (through the chest tube on the surgery side) were measured after surgery in 28 patients immediately after lobectomy or wedge resection. Measurements were made in the nondependent lateral position (without or with ventilation of the operated lung) and in the supine position. In the lateral position with the nondependent lung, collapsed or ventilated, the differences between esophageal and pleural pressure amounted to 4.4 ± 1.6 and 5.1 ± 1.7 cmH2O. In the supine position, the difference amounted to 7.3 ± 2.8 cmH2O. In the supine position, the estimated compressive forces on the mediastinum were 10.5 ± 3.1 cmH2O and on the iso-gravitational pleural plane 3.2 ± 1.8 cmH2O. A simple model describing the roles of chest, lung, and pneumothorax volume matching on the pleural pressure genesis was developed; modeled pleural pressure = 1.0057 × measured pleural pressure + 0.6592 ( r2 = 0.8). Whatever the position and the ventilator settings, the esophageal pressure changed in a 1:1 ratio with the changes in pleural pressure. Consequently, chest wall elastance (Ecw) measured by intrathoracic (Ecw = ΔPpl/tidal volume) or esophageal pressure (Ecw = ΔPes/tidal volume) was identical in all the positions we tested. We conclude that esophageal and pleural pressures may be largely different depending on body position (gravitational forces) and lung-chest wall volume matching. Their changes, however, are identical. NEW & NOTEWORTHY Esophageal and pleural pressure changes occur at a 1:1 ratio, fully justifying the use of esophageal pressure to compute the chest wall elastance and the changes in pleural pressure and in lung stress. The absolute value of esophageal and pleural pressures may be largely different, depending on the body position (gravitational forces) and the lung-chest wall volume matching. Therefore, the absolute value of esophageal pressure should not be used as a surrogate of pleural pressure.

Effect of body posture on lung volumes

1961 ◽  
Vol 16 (1) ◽  
pp. 27-29 ◽  
Author(s):  
Francisco Moreno ◽  
Harold A. Lyons
Keyword(s):  
Tidal Volume ◽  
Prone Position ◽  
Supine Position ◽  
Total Lung Capacity ◽  
Minute Ventilation ◽  
Normal Subjects ◽  
Body Posture ◽  
Mean Values ◽  
Lung Capacity ◽  
Residual Capacity

The changes produced by body posture on total lung capacity and its subdivisions have been reported for all positions except the prone position. Twenty normal subjects, twelve males and eight females, had determinations of total lung capacity in the three body positions, sitting, supine and prone. Tidal volume, minute ventilation and O2 consumption were also measured. The changes found on assumption of the supine position from the sitting position were similar to those previously reported. For the prone position, a smaller inspiratory capacity and a larger expiratory reserve volume were found. The mean values were changed, respectively, –8% and +37%. Associated with these changes was a significant increase of the functional residual capacity by 636 ml. Ventilation did not change significantly from that found during sitting, unlike the findings associated with the supine position, in which position the tidal volume was decreased. Respiratory frequency remained the same for all positions. Submitted on April 5, 1960

THE PULMONARY SYNDROME OF WILSON AND MIKITY

PEDIATRICS ◽  
1965 ◽  
Vol 36 (3) ◽  
pp. 374-384
Author(s):  
Paul R. Swyer ◽  
Maria Delivoria-Papadopoulos ◽  
Henry Levison ◽  
Bernard J. Reilly ◽  
John U. Balis
Keyword(s):  
Work Of Breathing ◽  
Respiratory Acidosis ◽  
Minute Volume ◽  
Lung Mechanics ◽  
Arterial Oxygen ◽  
Wall Thickening ◽  
Alveolar Wall ◽  
Electron Microscopic ◽  
Elastic Resistance ◽  
Immature Lung

Eight examples of the Wilson-Mikity Syndrome are reported, 2 of whom died at 127 and 145 days of age respectively. The radiology of the condition is relatively specific and gives strong grounds for suspicion of the diagnosis when taken in the clinical context. Gross, histological, and electron microscopic examinations reveal areas of normality, emphysema, and immaturity. The electron microscope additionally shows areas where the alveolar wall thickening is due to the presence of smooth muscle, reticulin, and collagen. The most likely etiology is a disorder in postnatal alveolar development related to premature birth and functional use of an immature lung. There are changes in lung mechanics with decreased compliance and increased non-elastic resistance to airflow mainly in expiration. The mechanical work of breathing is increased. There is a respiratory acidosis in spite of an increased minute volume. Arterial oxygen desaturation is common, increased by crying and only partially relieved by oxygen. Large R → L shunts have been demonstrated which are probably intrapulmonary.

A BAROMETRIC METHOD FOR MEASURING VENTILATION IN NEWBORN INFANTS

PEDIATRICS ◽  
1955 ◽  
Vol 16 (1) ◽  
pp. 81-87 ◽  
Author(s):  
James E. Drorbaug ◽  
Wallace O. Fenn
Keyword(s):  
Tidal Volume ◽  
Premature Infants ◽  
Newborn Infants ◽  
Minute Volume ◽  
Standard Methods ◽  
Minimum Disturbance

A barometric method for measurement of ventilation of newborn infants is described. Experiments with cats are reported to show the degree of accuracy obtainable at present. The variation from standard methods was found to average±1 per cent. Minute volume, frequency, and tidal volume of premature infants measured by the barometric method are within the range of such measurements made by plethysmographic methods. The barometric principle deserves further study since it offers the possibility of securing ventilation data with a minimum disturbance to the infant.

THE EFFECT OF POSITION ON THE RESPIRATORY RATE OF PREMATURE AND MATURE NEWBORN INFANTS

PEDIATRICS ◽  
1958 ◽  
Vol 22 (3) ◽  
pp. 432-435
Author(s):  
Harvey Kravitz ◽  
Lawrence Elegant ◽  
Bernard Block ◽  
Mary Babakitis ◽  
Evelyn Lundeen
Keyword(s):  
Respiratory Rate ◽  
Premature Infant ◽  
Prone Position ◽  
Premature Infants ◽  
Supine Position ◽  
Newborn Infants ◽  
Full Term ◽  
Term Infants ◽  
Definite Effect

Values for respiratory rates in the supine and prone positions in 96 premature and 49 full-term infants have been presented. Premature infants have a significant increase in respiratory rate in the prone position compared to the supine position. This difference decreases with increasing weight and age. Mature infants show a slight increase in respiratory rate in the prone compared to the supine position. The position of the premature infant has a definite effect on the physiology of respiration. Further studies must be done to establish whether the supine or prone position is superior. Irregularity of rate and amplitude of respirations are noted in the supine position, while respirations of regular rate and amplitude are frequently found in the prone position. The amplitude of respiration was greater in the supine position than in the prone position.

scholarly journals Awake prone position reduces work of breathing in patients with COVID-19 ARDS supported by CPAP

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Davide Chiumello ◽  
Elena Chiodaroli ◽  
Silvia Coppola ◽  
Simone Cappio Borlino ◽  
Claudia Granata ◽  
...  
Keyword(s):  
Gas Exchange ◽  
Prone Position ◽  
Supine Position ◽  
Minute Ventilation ◽  
Work Of Breathing ◽  
Invasive Mechanical Ventilation ◽  
Transpulmonary Pressure ◽  
Esophageal Pressure ◽  
Pressure Time ◽  
Pressure Swing

Abstract Background The use of awake prone position concomitant to non-invasive mechanical ventilation in acute respiratory distress syndrome (ARDS) secondary to COVID-19 has shown to improve gas exchange, whereas its effect on the work of breathing remain unclear. The objective of this study was to evaluate the effects of awake prone position during helmet continuous positive airway pressure (CPAP) ventilation on inspiratory effort, gas exchange and comfort of breathing. Methods Forty consecutive patients presenting with ARDS due to COVID-19 were prospectively enrolled. Gas exchange, esophageal pressure swing (ΔPes), dynamic transpulmonary pressure (dTPP), modified pressure time product (mPTP), work of breathing (WOB) and comfort of breathing, were recorded on supine position and after 3 h on prone position. Results The median applied PEEP with helmet CPAP was 10 [8–10] cmH2O. The PaO2/FiO2 was higher in prone compared to supine position (Supine: 166 [136–224] mmHg, Prone: 314 [232–398] mmHg, p < 0.001). Respiratory rate and minute ventilation decreased from supine to prone position from 20 [17–24] to 17 [15–19] b/min (p < 0.001) and from 8.6 [7.3–10.6] to 7.7 [6.6–8.6] L/min (p < 0.001), respectively. Prone position did not reduce ΔPes (Supine: − 7 [− 9 to − 5] cmH2O, Prone: − 6 [− 9 to − 5] cmH2O, p = 0.31) and dTPP (Supine: 17 [14–19] cmH2O, Prone: 16 [14–18] cmH2O, p = 0.34). Conversely, mPTP and WOB decreased from 152 [104–197] to 118 [90–150] cmH2O/min (p < 0.001) and from 146 [120–185] to 114 [95–151] cmH2O L/min (p < 0.001), respectively. Twenty-six (65%) patients experienced a reduction in WOB of more than 10%. The overall sensation of dyspnea was lower in prone position (p = 0.005). Conclusions Awake prone position with helmet CPAP enables a reduction in the work of breathing and an improvement in oxygenation in COVID-19-associated ARDS.

Ventilatory response to forward acceleration

1960 ◽  
Vol 15 (5) ◽  
pp. 907-910 ◽  
Author(s):  
Fred W. Zechman ◽  
Neil S. Cherniack ◽  
Alvin S. Hyde
Keyword(s):  
Tidal Volume ◽  
Ventilatory Response ◽  
Work Of Breathing ◽  
Minute Volume ◽  
Alveolar Ventilation ◽  
Respiratory Frequency ◽  
Series Of Experiments ◽  
Nitrogen Elimination ◽  
Second Period

Two series of experiments dealing with the effect of forward acceleration on respiration in man were performed. In both series of studies the trunk was inclined 12 degrees in the direction of acceleration and a rate of onset of 1 g/sec. was used. In the first series, the effect of 5, 8 and 12 g on respiratory frequency, tidal volume, minute volume and nitrogen elimination was determined. Frequency increased, reaching an average of 39.2 cpm and tidal volumes decreased to an average of 318 cc at 12 g. The volume of nitrogen eliminated during a 30-second period, breathing O2 at 12 g, was essentially unchanged, suggesting that alveolar ventilation did not decrease. In the second series, O2 consumptions were measured before, during and after accelerations of 5, 8, 10, and 12 g. O2 consumptions increased with acceleration and it is presumed that the extra work of breathing may be an important contributing factor. Submitted on March 2, 1960

scholarly journals Adaptive Support Ventilation

2009 ◽  
Vol 111 (4) ◽  
pp. 863-870 ◽  
Author(s):  
Demet Sulemanji ◽  
Andrew Marchese ◽  
Paul Garbarini ◽  
Marc Wysocki ◽  
Robert M. Kacmarek
Keyword(s):  
Tidal Volume ◽  
Airway Pressure ◽  
Minute Volume ◽  
Lung Model ◽  
Lung Mechanics ◽  
Adaptive Support Ventilation ◽  
Support Ventilation ◽  
Group I ◽  
Adaptive Support ◽  
Group Ii

Background Adaptive support ventilation (ASV) allows the clinician to set a maximum plateau pressure (PP) and automatically adjusts tidal volume to keep PP below the set maximum. Methods ASV was compared to a fixed tidal volume of 6 ml/kg. ASV determined the respiratory rate and tidal volume based on its algorithms. Maximum airway pressure limit was 28 cm H2O in ASV. Six sets of lung mechanics were simulated for two ideal body weights: 60 kg, Group I; 80 kg, Group II. Positive end expiratory pressure was 8, 12, and 16 cm H2O, and target minute volume 120%, 150%, and 200% of predicted minute volume. Results ASV "sacrificed" tidal volume and minute ventilation to maintain PP in 9 (17%) of 54 scenarios in Group I and 20 (37%) of 54 scenarios in Group II. In Group I, the number of scenarios with PP of 28 cm H2O or more was 14 for ASV (26%) and 19 for 6 ml/kg (35%). In these scenarios, mean PP were ASV 28.8 +/- 0.86 cm H2O (min 28, max 30.3) and 6 ml/kg 33.01 +/- 3.48 cm H2O (min 28, max 37.8) (P = 0.000). In group II, the number of scenarios PP of 28 cm H2O or more was 10 for ASV (19%) and 21 for 6 ml/kg (39%). In these cases, mean PP values were ASV 28.78 +/- 0.54 cm H2O (min 28, max 29.6) and 6 ml/kg 32.66 +/- 3.37 cm H2O (min 28.2, max 38.2) (P = 0.000). Conclusion In a lung model with varying mechanics, ASV is better able to prevent the potential damaging effects of excessive PP (greater than 28 cm H2O) than a fixed tidal volume of 6 ml/kg by automatically adjusting airway pressure, resulting in a decreased tidal volume.

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