Thoracoabdominal Asynchrony Is Not Associated with Oxyhemoglobin Saturation in Recovering Premature Infants

Abstract

Background: Recovering premature infants are at risk for hypoxemia and lack of synchrony between their rib cage and abdomen due to airflow obstruction and poor respiratory compliance. Thoracoabdominal asynchrony (TAA) is a useful marker of resistive and elastic lung properties. Whether TAA predicts oxygenation is unknown. Objectives: We investigated oxyhemoglobin saturation (SpO₂%) and TAA (phase angle, φ) in preterm infants with/without high-humidity nasal cannula (HHNC). Methods: A cross-sectional observational study was conducted in 92 infants at 32 weeks' postmenstrual age. We measured SpO₂% with pulse oximetry and TAA with φ via respiratory inductance plethysmography in infants (mean gestational age: 26.4 + 1.3 weeks) who required room air (n = 18) or HHNC with/without supplemental oxygen (1-5 liters per minute, FiO₂ 0.21-0.33, n = 74). We calculated median SpO₂% from 24.7 + 10.0 min of quiet sleep and median φ from up to 60 breaths. Results: Infants breathing room air alone had marked TAA (φ = 83.6 + 32.9°, range: 10.9-148.5) as did those receiving varying degrees of ventilatory and oxygen support via HHNC (range of group means, φ = 47.0-90.0°). Infants breathing room air had statically greater median SpO₂% than those receiving support (96.3 + 0.6% vs. 91.3 + 0.6%; ANOVA p = 0.001). SpO₂% was not associated with TAA in either group (r² = 0.09). Conclusion: Recovering premature infants exhibited TAA regardless of need for ventilatory support and supplemental oxygen. TAA was not associated with SpO₂% in either group. Maintenance of SpO₂% does not require correction of TAA.

Tidal Breathing Measurements at Discharge and Clinical Outcomes in Extremely Low Gestational Age Neonates

“…studies, we did not directly measure Tpef/Te with a pneumotachometer; rather, it was derived from changes in the sum of thoracic and abdominal expansion over time, changes in flow whose detection could be delayed when the measurements rely on rib cage or abdominal excursion. Finally, among infants studied at 32 weeks PMA, it has been shown that some infants are able to keep their Sp O 2 % greater than 90% in room air, despite having marked asynchrony, with PA much greater than 80 8 in many cases (44). In summary, we have shown that extremely low GA neonates breathing ambient air or on low-flow nasal cannula support have abnormal tidal breathing patterns, but these patterns do not differ between infants with and without BPD.…”

Effects of respiratory physiotherapy interventions on pulmonary mechanics of newborns: a protocol for a systematic review

“…Two reviewers (AdMN and ATdCS) will independently assess the risk of bias using the following domains of the PEDro scale: eligibility criteria, random allocation, concealed allocation, baseline comparability, blinding of participants, blinding of therapists, blinding of assessors, adequate follow-up, intention-to-treat analysis, betweengroup comparisons and measures of variability. The total scores of the scale range from 0 to 10, and risk of bias will be interpreted as high (0-3), moderate (5-7) or low (8)(9)(10). 16 Results will be presented in a table containing the name of authors and scores obtained on each item of the PEDro Scale.…”

“…In contrast, non-conventional techniques are usually employed according to anatomical and physiological differences of each age group. [4][5][6] Although conventional and nonconventional physiotherapy are commonly used in neonatal intensive care units to improve secretion mobilisation and thoracoabdominal repercussion, [5][6][7][8][9][10][11][12] the effects on pulmonary mechanics of newborns are still nuclear. Therefore, this systematic review aims to evaluate the effects of conventional and non-conventional respiratory physiotherapies, respiratory pattern, pulmonary…”

“…Although conventional and non-conventional physiotherapy are commonly used in neonatal intensive care units to improve secretion mobilisation and thoracoabdominal repercussion,5–12 the effects on pulmonary mechanics of newborns are still nuclear. Therefore, this systematic review aims to evaluate the effects of conventional and non-conventional respiratory physiotherapies, respiratory pattern, pulmonary mechanics and pain in newborns and identify protocols for respiratory physiotherapy used in this population.…”

Respiratory synchrony comparison between preterm and full‐term neonates using inertial sensors

“…As expected, the occurrence of periodic respiratory patterns, characterized by periods of insufficient breathing, pauses, or apneas, tends to decline with gestational age. 29 Brennan et al 30 investigated the TA asynchrony in children at 32 weeks of postmenstrual age through the RIP and reported an asynchronous TA pattern in preterm infants regardless of the need for ventilatory support or oxygen therapy. Another outcome of our study, although the difference was not statistically significant when compared to the PTG, is the occurrence of paradoxical TA pattern in 37% of the breathing cycles in the FTG.…”