Although endoscopic studies in adult humans have suggested that laryngeal closure can limit alveolar ventilation during nasal intermittent positive pressure ventilation (nIPPV), there are no available data regarding glottal muscle activity during nIPPV. In addition, laryngeal behavior during nIPPV has not been investigated in neonates. The aim of the present study was to assess laryngeal muscle response to nIPPV in nonsedated newborn lambs. Nine newborn lambs were instrumented for recording states of alertness, electrical activity [electromyograph (EMG)] of glottal constrictor (thyroarytenoid, TA) and dilator (cricothyroid, CT) muscles, EMG of the diaphragm (Dia), and mask and tracheal pressures. nIPPV in pressure support (PS) and volume control (VC) modes was delivered to the lambs via a nasal mask. Results show that increasing nIPPV during wakefulness and quiet sleep led to a progressive disappearance of Dia and CT EMG and to the appearance and subsequent increase in TA EMG during inspiration, together with an increase in trans-upper airway pressure (TUAP). On rare occasions, transmission of nIPPV through the glottis was prevented by complete, active glottal closure, a phenomenon more frequent during active sleep epochs, when irregular bursts of TA EMG were observed. In conclusion, results of the present study suggest that active glottal closure develops with nIPPV in nonsedated lambs, especially in the VC mode. Our observations further suggest that such closure can limit lung ventilation when raising nIPPV in neonates. thyroarytenoid muscle; cricothyroid muscle; diaphragm; states of alertness; intermittent positive-pressure ventilation NASAL INTERMITTENT positive-pressure ventilation (nIPPV) is increasingly used in the neonatal period (12) as treatment for respiratory distress syndrome (22) and apneas of prematurity (3,27) and as a bridge between endotracheal tube ventilation and spontaneous ventilation (6,19). Previous studies using endoscopic observations in adult humans have shown that laryngeal closure can occur during nIPPV, especially in the volume control (VC) mode (17, 18, 34 -36). In addition, laryngeal closure appears to increase with increasing ventilatory support, together with decreasing subglottal (alveolar) ventilation (40). Such laryngeal behavior is of high clinical importance since it has been linked to falls in oxygen saturation when increasing nIPPV during sleep in adult humans (7) and could divert positive pressure from the airways, leading to increased gastric distension (11). However, although the glottal closure observed endoscopically during nIPPV suggests an active contraction of glottal constrictor muscles, there are, to our knowledge, no data on glottal muscle electromyograms (EMG) during nIPPV. Moreover, there are no currently available studies on laryngeal dynamics during nIPPV in the neonatal period. Thus the aim of the present study was to test the hypotheses that 1) glottal narrowing during nIPPV is also present in the neonatal period, especially in the VC mode; and 2) glottal...
