Oscillatory respiratory mechanics on the first day of life improves prediction of respiratory outcomes in extremely preterm newborns

Veneroni, Chiara; Wallström, Linda; Sindelar, Richard; Dellacà, Raffaele L.

doi:10.1038/s41390-018-0133-6

Cited by 24 publications

(37 citation statements)

References 28 publications

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“…The current study does not address the marked nonlinearities present in the upper airways and flow-limiting bronchial segments, causing large intra-breath fluctuations in R rs and X rs [31][32][33][34][35], a factor potentially affecting the device-subject interaction and hence the device performance. However, new modalities of oscillometry that widen the utility of this method in lung function testing [33,34] and monitoring [36], impose further requirements over the accuracy of mean R rs and X rs .…”

Section: Discussionmentioning

confidence: 99%

“…The tested devices employed different oscillation signals (table 2), with frequency values ranging from 5 Hz to [35][36][37] Hz, except in the Quark i2m device whose lowest frequency was 4 Hz and highest was 48 Hz. In order to calculate the reactance area (A X ) between the lowest frequency and the resonance frequency ( f res ) uniformly, the values of reactance (X m ) at 5 Hz were interpolated from the 4-Hz and 6-Hz data.…”

Section: Oscillation Frequenciesmentioning

confidence: 99%

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Comparison of oscillometry devices using active mechanical test loads

et al. 2019

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Noninvasiveness, low cooperation demand and the potential for detailed physiological characterisation have promoted the use of oscillometry in the assessment of lung function. However, concerns have been raised about the comparability of measurement outcomes delivered by the different oscillometry devices. The present study compares the performances of oscillometers in the measurement of mechanical test loads with and without simulated breathing.Six devices (five were commercially available and one was custom made) were tested with mechanical test loads combining resistors (R), gas compliances (C) and a tube inertance (L), to mimic respiratory resistance (R rs ) and reactance (X rs ) spectra encountered in clinical practice. A ventilator was used to simulate breathing at tidal volumes of 300 and 700 mL at frequencies of 30 and 15 min −1 , respectively. Measurements were evaluated in terms of R, C, L, resonance frequency ( f res ), reactance area (A X ) and resistance change between 5 and 20 or 19 Hz (R 5-20(19) ).Increasing test loads caused progressive deviations in R rs and X rs from calculated values at various degrees in the different oscillometers. While mean values of R rs were recovered acceptably, some devices exhibited serious distortions in the frequency dependences of R rs and X rs , leading to large errors in C, L, f res , A X and R 5-20(19) . The results were largely independent of the simulated breathing.Simplistic calibration procedures and mouthpiece corrections, in addition to unknown instrumental and signal processing factors, may be responsible for the large differences in oscillometry measures. Rigorous testing and ongoing harmonisation efforts are necessary to better exploit the diagnostic and scientific potential of oscillometry. @ERSpublicationsThe clinical utility of oscillometry is limited by the lack of standardisation of devices. This study tested six oscillometers, and reveals very different performances at higher mechanical impedances observed in children and adults with lung disease. http://bit.ly/317sfjHCite this article as: Dandurand RJ, Lavoie J-P, Lands LC, et al. Comparison of oscillometry devices using active mechanical test loads.

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Section: Discussionmentioning

confidence: 99%

Section: Oscillation Frequenciesmentioning

confidence: 99%

Comparison of oscillometry devices using active mechanical test loads

et al. 2019

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“…Therefore, we evaluated Xrs during incremental/decremental PEEP trials because, by observing Xrs changes during this procedure, it is possible to obtain information about lung volume recruitability and distensibility with PEEP ( 12 , 14 ) and to identify the PEEP providing the optimal compromise between alveolar recruitment and lung tissue stress ( 8 – 10 ).…”

Section: Case Reportmentioning

confidence: 99%

“…From the relationship between the forcing pressure and the resulting oscillatory flow, the mechanical properties of the respiratory system can be estimated regardless of the presence of spontaneous breathing activities. The FOT has been validated for the assessment of lung volume recruitment and the identification of the optimal mechanical open-lung PEEP ( 7 – 10 ), and has been applied in animal models of prematurity ( 11 ) and mechanically ventilated preterm infants ( 12 – 14 ).…”

Section: Introductionmentioning

confidence: 99%

Role of Lung Function Monitoring by the Forced Oscillation Technique for Tailoring Ventilation and Weaning in Neonatal ECMO: New Insights From a Case Report

et al. 2018

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Respiratory management during extracorporeal membrane oxygenation (ECMO) is complex. Assessment of lung mechanics might support a patient-tailored ventilatory strategy. We report, for the first time, the use of the forced oscillation technique (FOT) to evaluate lung function during neonatal ECMO to improve the individualization of respiratory support. The patient was a formerly preterm infant at a corrected age of 40 weeks (gestational age 32 weeks) undergoing veno-arterial ECMO for refractory respiratory failure secondary to influenza A (H1N1) pneumonia. We used the FOT as a bedside non-invasive tool for daily monitoring of lung mechanics, from ECMO day 6 (E6) until decannulation. A small-amplitude, 5-Hz oscillatory pressure was overimposed on the ventilation waveform at the airway opening during positive end-expiratory pressure (PEEP) trials. From E6 to E9, lung mechanics changes with PEEP indicated a largely de-recruited and easily over-distendable lung that was not recruitable by applying lung-protective PEEP values. After surfactant and steroid administration, oscillatory reactance (Xrs) values began improving, suggesting a more recruited and pressure-recruitable lung. On E11, despite the lack of improvement in the radiographic appearance of the thorax, the FOT measurements showed a more recruited lung. Weaning from ECMO was started, and the patient was extubated within 48 h. The decannulation was successful, and the patient was extubated within 48 h after ECMO weaning. First-year respiratory and neurodevelopmental follow-up evaluation was unremarkable. This report suggests the potential usefulness of the FOT for monitoring the lung mechanics of ventilated newborns during ECMO to achieve individualized respiratory management. Such tailoring might improve neonatal outcomes and support clinicians with the establishment of a timely and safer weaning approach. These findings need to be verified on a larger population.

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“…The forced oscillation technique (FOT) allows monitoring of the resistance (Rrs) and the reactance (Xrs) of the total respiratory system by applying a small-amplitude, high-frequency pressure stimulus at the airway opening and measuring the flow response. In particular, Xrs at 5 Hz (X 5 ) provides information on the degree [11][12][13][14][15] and progression 16 of lung volume recruitment when measured at a constant distending pressure.…”

Section: Introductionmentioning

confidence: 99%

Changes in respiratory mechanics at birth in preterm infants: A pilot study

Veneroni

Mercadante

Lavizzari

et al. 2020

Pediatric Pulmonology

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Objective We aimed to measure lung mechanics at birth by the forced oscillation technique (FOT) for assessment of the initial degree of lung aeration and the short‐term aeration changes after applying different respiratory support strategies. Methods Eighteen preterm infants (gestational age = 29‐36 week) were randomized to receive either continuous positive airway pressure (CPAP) at 5 cmH2O only or combined with a sustained inflation (SI; 15 seconds at 25 cmH2O after 5 seconds of CPAP) at birth. We assessed the respiratory system reactance at 5 Hz (X5; increases with lung volume recruitment at a given distending pressure) at 2, 40, and 150 seconds after initiation of CPAP. k‐Means clustering of the initial X5 value (X5,i) stratified newborn into either infants with lower (lowerX5,i; X5 < −280 cmH2O*s/L) and higher (higherX5,i; X5 > −240 cmH2O*s/L) initial degree of lung volume recruitment. Results Initial values were highly heterogeneous. In the LowerX5,i group, X5 increased with time, with SI‐patients showing significantly higher values at 150 seconds than the non‐SI group (X5 = −89 ± 27 cmH2O vs −274 ± 58 cmH2O). In the higherX5,i group, X5 did not improve with time, regardless of the respiratory strategy, suggesting a lack of lung recruitment. Moreover, 75% of infants receiving SI in the higherX5,i group experienced a transient loss of aeration after the maneuver. Conclusions Preterm newborns present initially with highly heterogeneous lung aeration at birth that significantly impacts the effectiveness of the subsequent lung volume recruitment strategy. FOT may represent a valuable tool for individualizing a respiratory resuscitation at birth as it is noninvasive and may be applied simultaneously to respiratory support.

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Oscillatory respiratory mechanics on the first day of life improves prediction of respiratory outcomes in extremely preterm newborns

Abstract: FOT can be applied bedside in ELGANs, where early changes in lung mechanics with PEEP improve clinical prediction of respiratory outcomes.

Cited by 24 publications

References 28 publications

Comparison of oscillometry devices using active mechanical test loads

Comparison of oscillometry devices using active mechanical test loads

Role of Lung Function Monitoring by the Forced Oscillation Technique for Tailoring Ventilation and Weaning in Neonatal ECMO: New Insights From a Case Report

Changes in respiratory mechanics at birth in preterm infants: A pilot study

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