A model investigation of the impact of ventilation–perfusion mismatch on oxygenation during apnea in preterm infants

Sands, Scott A.; Edwards, Bradley A.; Kelly, Vanessa J.; Davidson, Malcolm R.; Wilkinson, Marcia; Berger, Philip J.

doi:10.1016/j.jtbi.2010.03.041

Cited by 16 publications

(12 citation statements)

References 37 publications

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“…Yet, to date, the propensity for additional rapid desaturation with a ventilatory challenge (breath-holding) has not been examined as a risk factor. In principle, breath-holding is expected to yield rapid desaturation in those with early gas exchange deficits (V/Q heterogeneity and reduced functional lung gas volumes [ 16 – 18 ]) beyond baseline SpO 2 . Moreover, in the context of anecdotal reports of “silent hypoxemia” (disproportionate tolerance of hypoxemia) as a characteristic of COVID-19 [ 19 , 20 ], we and others [ 21 , 22 ] considered that blunted ventilatory control (reduced chemosensitivity) may be an adverse neurophysiological consequence of infection, and could feasibly predispose to respiratory failure.…”

Section: Introductionmentioning

confidence: 99%

Breath-holding as a novel approach to risk stratification in COVID-19

et al. 2021

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Background Despite considerable progress, it remains unclear why some patients admitted for COVID-19 develop adverse outcomes while others recover spontaneously. Clues may lie with the predisposition to hypoxemia or unexpected absence of dyspnea (‘silent hypoxemia’) in some patients who later develop respiratory failure. Using a recently-validated breath-holding technique, we sought to test the hypothesis that gas exchange and ventilatory control deficits observed at admission are associated with subsequent adverse COVID-19 outcomes (composite primary outcome: non-invasive ventilatory support, intensive care admission, or death). Methods Patients with COVID-19 (N = 50) performed breath-holds to obtain measurements reflecting the predisposition to oxygen desaturation (mean desaturation after 20-s) and reduced chemosensitivity to hypoxic-hypercapnia (including maximal breath-hold duration). Associations with the primary composite outcome were modeled adjusting for baseline oxygen saturation, obesity, sex, age, and prior cardiovascular disease. Healthy controls (N = 23) provided a normative comparison. Results The adverse composite outcome (observed in N = 11/50) was associated with breath-holding measures at admission (likelihood ratio test, p = 0.020); specifically, greater mean desaturation (12-fold greater odds of adverse composite outcome with 4% compared with 2% desaturation, p = 0.002) and greater maximal breath-holding duration (2.7-fold greater odds per 10-s increase, p = 0.036). COVID-19 patients who did not develop the adverse composite outcome had similar mean desaturation to healthy controls. Conclusions Breath-holding offers a novel method to identify patients with high risk of respiratory failure in COVID-19. Greater breath-hold induced desaturation (gas exchange deficit) and greater breath-holding tolerance (ventilatory control deficit) may be independent harbingers of progression to severe disease.

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Section: Introductionmentioning

confidence: 99%

Breath-holding as a novel approach to risk stratification in COVID-19

et al. 2021

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“…This problem may be overcome with oxygen being delivered via nasal cannulae. Neonates require special attention, and premature babies in particular, as they are sensitive to excessive oxygen therapy/delivery while, on the other hand, being prone to hypoxia related to hypoventilation [13,44]. Cautious pre-oxygenation is recommended in this group of patients, although there are no clear guidelines regarding either the technique or its the length [33,36].…”

Section: Stage I: Standard Intubationmentioning

confidence: 99%

“…Children, when compared to adults, are characterised by higher oxygen consumption and less oxygen reserve. This results in a worse tolerance of respiratory interruptions and leads to faster desaturation and subsequent bradycardia [13,14]. The problem of difficult airways in children is more frequent in emergency setting and intensive care units than in the operating theatre.…”

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confidence: 99%

Postępowanie w niespodziewanych trudnych drogach oddechowych u dzieci — stanowisko Sekcji Anestezjologii i Intensywnej Terapii Dziecięcej, Sekcji Przyrządowego Udrażniania Dróg Oddechowych Polskiego Towarzystwa Anestezjologii i Intensywnej Terapii oraz Po

Walas¹,

Aleksandrowicz²,

Borszewska−Kornacka³

et al. 2017

Anaesthesiol Intensive Ther

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“…This model used the concept of shunts to simulate pathological conditions in a neonate. In different models, Sands et al showed possibilities how to describe impaired gas transfer across the alveolar-capillary membrane by ventilation-perfusion mismatch [5] or elevated alveolarcapillary diffusion resistance [6]. In our project [7], Morozoff's model was enhanced in several ways; primarily a diffusion resistance (Rdiff) has been introduced into the model and the range of some physiological parameters of the model was estimated from neonatal literature rather than scaling from adults.…”

Section: Introductionmentioning

confidence: 99%

Sensitivity analysis of a computer model of neonatal oxygen transport

Huttova

Ráfl

Bachman

et al. 2020

Current Directions in Biomedical Engineering

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Computer models of neonatal oxygenation could serve as a tool for a comprehensive comparison of closed-loop automated oxygen control systems. The behaviour of such models depends, besides the input data of the inspired fraction of oxygen and the premature infant's breath pattern, on internal parameters of the model. The aim of this study was to perform a sensitivity analysis of a computer model of neonatal oxygen transport to clarify the influence of its internal physiological parameters on the output signal of peripheral oxygen saturation (SpO2). We performed a multi-parameter sensitivity analysis using Monte Carlo simulations for randomly generated values of eight internal parameters. The influence on the model output SpO2 signal was evaluated using five characteristics of the output signal. The relations between the parameters and the output characteristics were displayed using scatter plots and analysed by linear correlation, standardized regression, and partial correlation. The main result of the study is that in our model the oxygen consumption in the tissue and the cardiac output have the greatest influence on the SpO2 drop and minimal SpO2 value during simulated desaturation. The rate of development of desaturation and its duration are most affected by the diffusion resistance of the alveolar-capillary membrane. The results of the sensitivity analysis will help to optimize the performance of the computer model of neonatal oxygen transport.

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A model investigation of the impact of ventilation–perfusion mismatch on oxygenation during apnea in preterm infants

Cited by 16 publications

References 37 publications

Breath-holding as a novel approach to risk stratification in COVID-19

Breath-holding as a novel approach to risk stratification in COVID-19

Postępowanie w niespodziewanych trudnych drogach oddechowych u dzieci — stanowisko Sekcji Anestezjologii i Intensywnej Terapii Dziecięcej, Sekcji Przyrządowego Udrażniania Dróg Oddechowych Polskiego Towarzystwa Anestezjologii i Intensywnej Terapii oraz Po

Sensitivity analysis of a computer model of neonatal oxygen transport

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