Continuous Regional Analysis Device for Neonate Lung (CRADL) (original) (raw)
2016, IFMBE Proceedings
https://doi.org/10.1007/978-3-319-32703-7_35
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Abstract
Full bibliographic details must be given when referring to, or quoting from full items including the author's name, the title of the work, publication details where relevant (place, publisher, date), pagination, and for theses or dissertations the awarding institution, the degree type awarded, and the date of the award.
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Journal of Maternal-Fetal and Neonatal Medicine, 2011
In clinical practice, one of the major problems in optimizing recruitment or lung volume during HFOV in preterm infants is the inability to accurately measure direct changes in lung volume at bedside. Objective: To evaluate changes in lung volume during the recruitment phase of elective HFOV in preterm infants with RDS using respiratory inductive plethysmography. Material and methods: The preliminary results of an observational prospective study were reported. Newborns with GA ≤ 27 weeks requiring elective HFOV for a diagnosis of RDS were studied within the first 6 hours of life using RIP technology, before surfactant instillation. HFOV was performed with Draeger Babylog 8000 plus ventilator with "optimum lung volume strategy "(continuous distending pressure (CDP) increased step-by-step until FiO 2 ≤ 0.25 was reached). Data on ventilator settings, gas exchange and RIP volume were collected and analyzed. The analysis package used in this study visualizes measured data from the Bicore-II device (CareFusion), Pulse Oximeter Masimo, AX300 FiO 2 monitor device and TCM4 shuttle (TCM4, Radiometer, Copenaghen, Denmark). Results: Four preterm infants (two females) with mean ± SD gestational age of 26.5 ± 1.0 weeks and mean ± SD birth weight of 978 ± 188 grams were studied. Relative FRC slightly increased during the first steps of the recruitment phase, while deeply decreased at higher CDP values (≥ 15 cm H 2 O). Notwithstanding FiO 2 decreased until 0.25 in all the newborns except one. Conclusions: Because RIP cannot differentiate between changes in lung fluid or intrathoracic gas, we hypothesized that as CDP increases and total lung capacity is approached, pulmonary vascular resistance increases as a consequence of the compression of intra-alveolar vessels. This increases right ventricular afterload which, combined with re-establishment of right-to left shunting, results in decreased pulmonary blood flow and then decreased lung volume. Caution should then be used when using high CDP values during the recruitment procedure.
Comparison of four methods to calibrate respiratory inductive plethysmograph in premature infants
Critical Care, 2006
Objective To examine the effects of short-term cyclic stretch on apoptosis in alveolar type II cells (A549). To study in vitro the direct influence of alveolar type II cells on mechanical stretch. Methods A549 were treated with different doses of lipopolysaccharide (LPS), 0 ng/ml, 1 ng/ml, 10 ng/ml, 100 ng/ml, 1000 ng/ml, and then A549 were lengthened 5%, 15%, 30% using a FLEXCELL tension unit 4000, a vacuum-driven device that applies strain to cells, which were cultured in six-well plates coated with collagen-I, and 12 cycles/min for 4 hours. Apoptosis was measured using the flow cytometry method that measures annexin V and propidium iodide (PI) staining. The morphological changes of apoptotic cells were observed by transmission electron microscope. Results Apoptosis could be induced in alveolar type II cells (A549) by mechanical stretch. The percentage of annexin V + PI cells increased after being treated with cyclic stretch for 4 hours by 5%, 15%, 30% in all groups. The morphological features of apoptotic cells demonstrated by transmission electron microscope were as follows: shrinkage of the cell, chromatin condensation and aggregation under the nuclear membrane as a crescent or lump, membrane-encapsulated nuclear fragment or cell organ formed by invagination of the cell membrane, and apoptotic body formation followed by vacuolization. Conclusion Apoptosis induced by mechanical stretch and LPS is dose dependent. Mechanical stretch aggravates apoptosis especially in cells treated with LPS. Annexin V and PI double staining is a specific, sensitive, and quantitative method for analyzing apoptotic cells. It is also helpful to clarify the protective mechanism of low-volume ventilation in ARDS. PaO 2 /FiO 2 430 [421; 440] # 380 [349; 397] 165 [68; 289] # C (ml/cmH 2 O) 28 [24; 32]* 18 [16; 21]* 12 [8; 17]* R i (cmH 2 O/l/s) 4.1 [3.9; 4.5] 4.5 [4.3; 5.1] 5.1 [3.7; 7.9] # P < 0.05 control vs 24-hour peritonitis, *P < 0.05 control vs 12-hour and 24-hour peritonitis.
Respiratory compliance in infants—a preliminary evaluation of the multiple interrupter technique
Pediatric Pulmonology, 1992
Measurements of total respiratory system compliance (Crs) using the multiple occlusion technique (MOT) in spontaneously breathing infants can be difficult to interpret in the presence of an unstable end-expiratory level. Similarly, measurements using the passive flow volume technique (PFV) are invalidated if there is alinearity of the expiratory time constant (Trs), irrespective of respiratory effort. For possibly overcoming these problems, we assessed the feasibility of a technique using multiple interruptions of of a single expiration (MIT), obtaining several pairs of volume-pressure data, from one expiration, which relate to a single end-expiratory level.
The Implantable Pediatric Artificial Lung
Asaio Journal, 2015
An implantable pediatric artificial lung (PAL) may serve as a bridge to lung transplantation for children with end-stage lung failure (ESLF); however, an animal model of pediatric lung failure is needed to evaluate a PAL's efficacy before it can enter clinical trials. The objective of this study was to assess ligation of the right pulmonary artery (rPA) as a model for pediatric ESLF. Seven 20-30kg lambs underwent rPA ligation and were recovered and monitored for up to 4 days. Intraoperatively, rPA ligation significantly increased physiologic deadspace fraction (Vd/Vt: baseline=48.6±5.7%, rPA ligation=60.1±5.2%, p=0.012), mean pulmonary arterial pressure (mP PA : baseline=17.4±2.2mmHg, rPA ligation=28.5±5.2mmHg, p<0.001), and arterial partial pressure of carbon dioxide (PaCO 2 : baseline=40.4±9.3mmHg, rPA ligation=57.3±12.7mmHg, p=0.026). Of the 7 lambs, 3 were unable to be weaned from mechanical ventilation postoperatively, 3 were successfully weaned but suffered cardiorespiratory failure within 4 days, and 1 survived all 4 days. All 4 animals that were successfully weaned from mechanical ventilation had persistent pulmonary hypertension (mP PA =28.6±2.2mmHg) and remained tachypneic (respiratory rate=63±21min −1). Three of the 4 recovered lambs required supplemental oxygen. We conclude that rPA ligation creates the physiologic derangements commonly seen in pediatric end-stage lung failure and may be suitable for testing and implanting a PAL.
Assessment of pulmonary function in resolving chronic lung disease of prematurity
Archives of Disease in Childhood - Fetal and Neonatal Edition, 1997
Aim-To investigate the longitudinal changes of interstitial and airways disease in resolving chronic lung disease of prematurity (CLD). Methods-Thirty three infants were studied between 35 and 40 weeks of postconceptional age, and then at three monthly intervals throughout their first year. Measurements of mean arterial oxygen saturation (MSaO 2 ) and its variability ( MSaO 2 ) were recorded. PaCO 2 and PaO 2 were determined while the infants breathed steady state 50% oxygen via a hood. From these, the alveolar arterial diVerence (A-a) Do 2 50 was calculated. Airway disease was assessed by the measurement of partial forced expiratory flow volume curves (PEFC) to give Ṽ max Frc. Results-The cohort mean +/-95% confidence intervals measured between 35 and 40 weeks were for MSaO 2 (89z25 +/-1z87%, range 75-96z5%) and MSaO 2 (4z79 +/-0z8%, range 0z16-9z64%), PaCO 2 (5z89 +/-0z56 kpa, range 4z2-10z11 kpa), (A-a) Do 2 50 (22z7 +/-2z56 kpa, range 6z67-31z4 kpa) and Ṽ max Frc (41z5 +/-8z65 mls/second, range 8z5-103z7 ml/second). The most significant improvement in all measurements occurred within the first three months (P = 0z05). An MSaO 2 of less than 90% in room air at 1 year of age was predicted between 35 and 40 weeks postconceptional age by an (A-a) Do 2 50 of greater than 29 kpa, with a sensitivity of 0z85 and a specificity of 0z88, and a PaCO 2 greater than 7 kpa predicted a specificity of 0z78 and a sensitivity of 0z88. Predictions were strengthened by combining the above criteria and these then gave a sensitivity and specificity of 1.
Clinical application of regional lung function studies in infants and small children using 13N
Archives of Disease in Childhood, 1975
Archives of Disease in Childhood, 50, 595. Clinical application of regional lung function studies in infants and small children using 13N. A technique is described for the investigation of regional lung function in infants and children using 13N and a gamma camera. Boluses of isotopic gas are inhaled and perfused while the lung fields are scanned. The child is lightly sedated and breathes normally throughout. Regional function is assessed in terms of the distribution of gas and blood, and the balance between ventilation and perfusion is estimated by comparing an index of the ventilation per unit volume of ventilated lung with that of perfused lung. The use of the method in 8 infants and children with different clinical problems is described to show its application. The method is capable of defining the severity and localization of any abnormality and may also be useful in showing normal function in suspect areas.
Referencing lung volume for measurements of respiratory system compliance in infants
Pediatric Pulmonology, 1993
We propose a method for measurements of respiratory system compliance (C ,) in spontaneously breathing infants, which circumvents the potential problems introduced by the breathby-breath oscillations in the end-expiratory level, i.e., functional respiratory capacity (FRC). Changes in lung volume (V) and pressure at the airway opening (P,) were measured in 10 infants breathing through a face mask. A first brief occlusion was to establish a reference V and the corresponding static Pao; a second occlusion was done at a different V. within the same expiration, or in the following breath. Both occlusions were sufficiently long for the establishment of a stable P, value. From the V difference (6V, where 6V was at least 20% tidal volume) and the corresponding difference in Pa, (tipm) C , was computed and averaged (C,[REF.VOL.] = tiV/tiP,). Although, on average, the results were similar to those obtained by the traditional multiple occlusions technique with linear regression analysis of the Pa,-V data points (C,[MOT]), in several infants C, [ FI EF. VCL] tended to be slightly higher than C,,[MOT]. Some possibilities for this discrepancy are discussed. It seems likely that breath-tobreath oscillation in FRC may potentially lower C,[MOT] by introducing a bias on the V measurement at low P,. We conclude that referencing V for C , measurements in spontaneously breathing infants is a simple approach, which does not require linear regression analysis and Circumvents the effects of oscillation in FRC. Pediatr Pulmonol. 1993; 16:2&253. o im w~iey-u~, IW.
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Prolonged Continuous Monitoring of Regional Lung Function in Infants with Respiratory Failure
Annals of the American Thoracic Society
At a Glance Commentary Scientific Knowledge on the Subject: Electrical impedance tomography (EIT) allows non-invasive and radiation-free monitoring of regional ventilation distribution and changes in end-expiratory lung volume in critically ill patients of all ages. In the vulnerable neonatal and pediatric population, EIT can be used to identify adverse events like atelectasis, pneumothorax and endotracheal tube malposition and potentially guide the personalized selection of ventilator settings. Previous studies have examined EIT in small patient groups during short measurement periods of only a few hours or less under highly controlled circumstances. What This Study Adds to the Field: In the Continuous Regional Analysis Device for Neonate Lungs (CRADL) project, we performed the first multi-center observational study on the use of EIT in critically ill neonates and young children with or at risk for respiratory failure. Including 200 patients, we demonstrated that continuous EIT monitoring for up to 72 hours is feasible, safe and can be used for continuous monitoring of ventilation distribution in neonates and infants in a routine clinical setting.
Accuracy of currently available neonatal respiratory function monitors for neonatal resuscitation
European Journal of Pediatrics, 2016
This study aimed to test the accuracy in volume measurements of three available respiratory function monitors (RFMs) for neonatal resuscitation and the effect of changing gas conditions. The Florian, New Life Box Neo-RSD (NLB Neo-RSD) and NICO RFM were tested on accuracy with volumes of 10 and 20 mL and on changes in volume measurements under changing gas conditions (oxygen level 21-100 % and from cold dry air (24 ± 2°C) to heated humidified air (37°C). Volume differences >10 % were considered clinically relevant. We found that the mean (SD) volume difference was clinically acceptable for all devices (10, 20 mL): Florian (+8.4 (1.2)%, +8.4 (0.5)%); NLB Neo-RSD (+5.8 (1.1)%, +4.3 (1.4)%); and NICO (−8.2 (0.9)%, −8.7 (0.8)%). Changing from cold dry to heated humidified air increased the volume difference using the Florian (cold dry air, heated humidified air (+5.2 (1.2)%, +12.2 (0.9)%) but not NLB Neo-RSD (+2.0(1.6)%, +3.4(2.8)%) and NICO (−2.3 % (0.8), +0.1 (0.6)%). Similarly, when using heated humidified air, increasing oxygen enlarged increased the volume difference using the Florian (oxygen 21 %, 100 %: +12.2(1.0)%, +19.8(1.1)%), but not NLB Neo-RSD (+0.2(1.9)%, +1.1(2.8)%) and NICO (−5.6(0.9)%, −3.7(0.9)%). Clinically relevant changes occurred when changing both gas conditions (Florian +25.7(1.7)%; NLB Neo-RSD +3.8(2.4)%; NICO −5.7(1.4)%). Conclusion: The available RFMs demonstrated clinically acceptable deviations in volume measurements, except for the Florian when changing gas conditions.
Iranian Journal of Pediatrics, 2019
Background: Continuous distending pressure (CDP) is considered as standard care in neonates with decreased pulmonary compliance. Concerns regarding the implementation of non-invasive CDP in a respiratory cycle in order to establish an optimal level of functional residual capacity (FRC) abound in the related literature. Examples include how to manage gas leakage in the interface, no imposed increased work of breath (WOB) on patients and prevention of applying trans-pulmonary pressure levels leading to metabolic acidosis. Following the development of autoflow hardware, pressure control (PC) respiratory pattern was defined in the field of mechanical ventilation (MV) in order to compensate for gas leakage in interface or compensate for pressure drop and increased CDP pressure level in respiratory phases of inspiration and expiration. The study aimed at decreasing WOB in neonates with RDS using pressure control-nCPAP. Methods: This study was a retrospective clinical trial performed on 70 neonates weighing about 1000 grams with RDS. Participants were randomly assigned into two respiratory support groups based on the use of pressure limited nCPAP (PL-nCPAP) and pressure control nCPAP (PC-nCPAP). Each group consisted of 35 infants compared in terms of their demographic characteristics, duration of non-invasive respiratory support, rapid shallow breathing (RSB) index, ventilator's WOB, need for MV, need for surfactant administration, chronic lung diseases, pneumothorax, intra-ventricular hemorrhage (IVH) and death. Results: No significant difference was observed between the mean time of non-invasive respiratory support and the need for MV, between the incidence of pneumothorax and IVH and also between the mortality rate and degree of involvement in chronic lung diseases in the two groups. The mean respiratory ventilation rate of ventilator's WOB in PC-nCPAP group was significantly higher than that of PL-nCPAP group. The mean RSB index was also significantly higher in PL-nCPAP group than in PC-nCPAP group. Finally, the mean of surfactant administration in PL-nCPAP group was significantly higher than that in PC-nCPAP group. Conclusions: In this study, ventilator's WOB in PC-nCPAP group, which was significantly higher than that of PL-nCPAP group, can be explained by significantly higher RSB index in PL-nCPAP group and significantly lower mean surfactant prescription in PC-nCPAP group.
Does measuring respiratory function improve neonatal ventilation?
Journal of Paediatrics and Child Health, 2006
To determine whether using a respiratory function monitor alters clinicians' choice of ventilator settings, tidal volumes or blood gases in the first 48 h of ventilation. Methods: Clinicians were trained to use a respiratory function monitor to optimize neonatal ventilation. Thirty-five infants, weighing < 2 kg, treated with the Infant Star ventilator were randomized to have a respiratory function monitor display visible or concealed. All reasons for altering ventilator settings were noted. Data on ventilator parameters and clinical care were collected hourly. The primary outcome was the mean peak pressure used during the first 48 h. Results: There were no statistically significant differences in peak pressures, tidal volumes or arterial carbon dioxide levels between the two groups. Conclusions: Using the Florian respiratory function monitor in the first 48 h of ventilation with the Infant Star ventilator did not alter the choice of ventilator settings, tidal or minute volumes or arterial blood gases. Possible explanations for this result include lack of power due to the small numbers recruited and bias due to the unblinded nature of the trial.
Continuous integrated distal capnography in infants ventilated with high frequency ventilation
Pediatric Pulmonology, 2012
To assess within a feasibility study the correlation, agreement, and trending of continuous integrated distal capnography (dCap) with PaCO 2 in infants on HFV. Study design: Sixteen premature infants [median (range) gestational age: 26.5 (24.7-34.7) weeks], ventilated with HFV (mean AE SD airway pressure: 8.1 AE 2.1 cmH 2 O, FiO 2 : 0.39 AE 0.21) for RDS, intubated with a double-lumen endotracheal-tube and whose data were recorded on a bedside computer participated in the study. Side-stream dCap was measured via the extra-port of a double-lumen endotracheal-tube by a Microstream capnograph, with a specially designed software for HFV and compared with simultaneous PaCO 2. Integrated timewindow analysis of the data was performed retrospectively on data collected prospectively. Results: Analysis included 195 measurements. The correlation of dCap with PaCO 2 (r ¼ 0.68, P < 0.0001) and the agreement (bias AE precision: À2.0 AE 10.7 mmHg) were adequate. Area under the ROC curves for dCap to detect high (>60 mmHg) or low (<35 mmHg) PaCO 2 was 0.79 (CI: 0.70-0.89) and 0.87 (CI: 0.73-1.00), respectively; P < 0.0001. Changes in dCap and in PaCO 2 for consecutive measurements within each patient were adequately correlated (r ¼ 0.65, P < 0.0001). Conclusions: Continuous integrated dCap is feasible in premature infants ventilated with HFV and can be helpful for trends and alarm for unsafe levels of PaCO 2 .