Volume targeting levels and work of breathing in infants with evolving or established bronchopulmonary dysplasia (original) (raw)
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The Journal of Pediatrics, 1988
To determine whether the high oxygen consumption Vo2 in infants with bronchopulmonary dysplasia (BPD) is caused by increased mechanical power of breathing, and if improvement of pulmonary mechanics would reduce mechanical power of breathing and Vo2 we gave 16 infants with oxygendependent BPD at 19.5 _+ 10.7 (mean _ SD) weeks of age placebo, theophylline, and orally administered diuretics or theophylline plus diuretics. Pulmonary mechanics, mechanical power of breathing, and Vo2 were measured at the beginning and end of each study period. In the placebo group, all infants had elevated Vo2 (7.4___ 1.4 mL/kg/min) and carbon dioxide production (6.6 + 1.2 mL/kg/min), increased airway resistance (59 _+ 30 cm H20/L/sec), decreased dynamic compliance (0.073 +_ 0.024 mL/cm H20/cm), increase respiratory rate (52 ___ 11), and increased mechanical power of breathing (2.22 _+ 1.05 kg 9 cm/kg/min). Treatment with theophylline, diuretics, and theophylline plus diuretics resulted in a significant improvement in pulmonary mechanics and mechanical power of breathing, but not in Vo2. These results suggest that the increased Vo2 in infants with BPD is not secondary to increased mechanical power of breathing. (J PEDIAI' R 1988;112:616-21) Infants with bronchopulmonary dysplasia often have caloric requirements that are 25% to 50% greater than those of normal infants. In one study, the oxygen consumption of infants with BPD was 25% greater than that of normal infants. ~ One explanation given for this elevation in oxygen consumption is that these infants have increased mechanical power of breathing 2 (work of breathing per unit time, proportional to tidal volume, respiratory rate, airway resistance, and the reciprocal of dynamic compliance3). If the elevated 902 in infants with BPD
Physiology and Predictors of Impaired Gas Exchange in Infants with Bronchopulmonary Dysplasia
American Journal of Respiratory and Critical Care Medicine, 2019
Short running head: Physiology of impaired gas exchange in BPD Descriptor: 14.3 Manuscript Body Word Count: 3639 At a Glance Commentary: Scientific Knowledge on the Subject: Assessment of impaired gas exchange may provide a continuous outcome measure for sensitive and equitable determination of severity of bronchopulmonary dysplasia (BPD). Previous gas exchange studies in BPD infants used small cohorts and targeted moderate-severe BPD. These studies show right shift of the peripheral oxyhemoglobin saturation (SpO2) versus inspired oxygen partial pressure (PIO2) curve and reduced ventilation-perfusion ratio reliably predict hypoxaemia in preterm infants breathing air, and further, that many infants also have a right-left shunt. What This Study Adds to the Field: We provide measures of right shift, ventilation/perfusion and shunt, across the full spectrum of lung disease in a large (n=219) group of preterm infants. Shift increases and ventilation/perfusion decreases with increased severity of BPD as defined by the NIH classification of BPD. Shunt is primarily a feature of infants with moderate-severe BPD who require supplemental oxygen. Non-invasive bedside assessment of shift, ventilation/perfusion and shunt provide physiological continuous outcome measures of severity of respiratory disease in very preterm infants with/without BPD independent of altitude and unit practices. Routine analysis of the SpO2/PIO2 curve may improve accuracy of BPD severity classification and provide a sensitive continuous outcome measure for clinical trials evaluating pulmonary outcomes.
Bronchopulmonary dysplasia (BPD) is a chronic respiratory disease associated with premature birth that primarily affects infants born at less than 28 weeks' gestational age. BPD is the most common serious complication experienced by premature infants, with more than 8,000 newly diagnosed infants annually in the United States alone. In light of the increasing numbers of preterm survivors with BPD, improving the current state of knowledge of long-term respiratory morbidity for infants with BPD is a priority. We undertook a comprehensive review of the published literature to analyze and consolidate current knowledge of the effects of BPD that are recognized at specific stages of life, including infancy, childhood, and adulthood. In this review, we discuss both the short-term and long-term respiratory outcomes of individuals diagnosed as infants with the disease and highlight the gaps in knowledge needed to improve early and lifelong management of these patients.
2017
Objective: To compare the clinical approach and outcomes of bronchopulmonary dysplasia (BPD) patients in the last two decades (1996-2005 vs 2006-2015) in a neonatal intensive care unit. Methods: Out of 1,196 admissions of very low birth weight and/or less than 32 weeks of gestational age infants, 96 had BPD and were dichotomized into two groups according to the year of birth (1996-2005 and 2006-2015). Their clinical data were studied and conclusions were drawn about their morbidity and mortality. Results: There was a decrease in mortality (23.3% vs. 14.4%, p < 0.001) and in BPD prevalence (9.7% vs 6.1%, p = 0.023); in the delivery room, early nasal continuous positive airways pressure (nCPAP) was used in 41.2% vs 1.6%, p < 0.001 and tracheal intubation in 70.6% vs 96.8%, p < 0.001. We observed an increase on the duration of non-invasive ventilation (nCPAP, 22.5 vs 45.5 days, p < 0.001) and a decrease of invasive ventilation (39.5 vs 20 days, p = 0.013) from the first to...
The relation between mechanical ventilation (MV) and bronchopulmonary dysplasia (BPD) is well stabilished, but is unknown, however, how much time under MV influences the severity of the disease. Aim: To define the duration under MV with greater chance to develop moderate to severe BPD (M/S BPD) in extremely PTNB and to compare clinical outcomes before and during hospitalization among patients with mild and M/S BPD. Methods: 53 PTNB were separated into mild and M/S BPD groups and their data were analyzed. Time under MV with a greater chance of developing M/S BPD was estimated by the ROC curve. Perinatal and hospitalization outcomes were compared between groups. A logistic regression was performed to verify the influence of variables associated to M/S BPD development, such as pulmonary hypertension (PH), gender, gestational age (GA) and weight at birth, as well the time under MV found with ROC curve. The result of ROC curve was validated using an independent sample (n=16) by Chi-squar...
Lung Volume, Breathing Pattern and Ventilation Inhomogeneity in Preterm and Term Infants
PLoS ONE, 2009
Background: Morphological changes in preterm infants with bronchopulmonary dysplasia (BPD) have functional consequences on lung volume, ventilation inhomogeneity and respiratory mechanics. Although some studies have shown lower lung volumes and increased ventilation inhomogeneity in BPD infants, conflicting results exist possibly due to differences in sedation and measurement techniques.
Effect of a new respiratory care bundle on bronchopulmonary dysplasia in preterm neonates
European Journal of Pediatrics
The development of devices that can fix the tidal volume in high-frequency oscillatory ventilation (HFOV) has allowed for a significant improvement in the management of HFOV. At our institution, this had led to the earlier use of HFOV and promoted a change in the treatment strategy involving the use of higher frequencies (above 15 Hz) and lower high-frequency tidal volumes (VThf). The purpose of this observational study was to assess how survival without bronchopulmonary dysplasia grades 2 and 3 (SF-BPD) is influenced by these modifications in the respiratory strategy applied to preterm infants (gestational age < 32 weeks at birth) who required mechanical ventilation (MV) in the first 3 days of life. We compared a baseline period (2012-2013) against a period in which this strategy had been fully implemented (2016-2017). A total of 182 patients were exposed to MV in the first 3 days of life being a higher proportion on HFOV at day 3 in the second period 79.5% (n 35) in 2016-2017 vs 55.4% (n 31) in 2012-2013. After adjusting for perinatal risk factors, the second period is associated with an increased rate of SF-BPD (OR 2.28; CI 95% 1.072-4.878); this effect is more evident in neonates born at a gestational age of less than 29 weeks (OR 4.87; 95% CI 1.9-12.48). Conclusions : The early use of HFOV combined with the use of higher frequencies and very low VT was associated with an increase in the study population's SF-BPD. What is Known: • High-frequency ventilation with volume guarantee improve ventilation stability and has been shown to reduce lung damage in animal models. What is New: • The strategy of an earlier use of high-frequency oscillatory ventilation combined with the use of higher frequencies and lower tidal volume is associated to an increase in survival without bronchopulmonary dysplasia in our population of preterm infants. Keywords High-frequencyventilation. Lung protection. Bronchopulmonary dysplasia. Ventilatory-induced lung injury. Target tidal volume. Preterm infants Abbreviations ΔPhf Delta pressure BPD Bronchopulmonary dysplasia type 2-3 BW Birth weight CMV Conventional mechanical ventilation CRIB Critical index for babies DOL Days of life GA Gestational age HFOV High-frequency oscillatory ventilation Hz Hertz INSURE Intubation-surfactant administration-extubation LISA Less-invasive surfactant administration MV Mechanical ventilation nCPAP Nasal continuous airway pressure NEC Necrotizing enterocolitis Communicated by Daniele De Luca
Lung function among infants born preterm, with or without bronchopulmonary dysplasia
Pediatric Pulmonology, 2012
Objective: Both healthy preterm infants and those with bronchopulmonary dysplasia (BPD) have poor lung function during childhood and adolescence, although there is no evidence whether prematurity alone explains the reduction in lung function found in BPD infants. Our study seeks to know if lung function, measured in infancy by means of rapid thoracic compression with raised volume technique, is different between preterm infants with and without BPD. Methods: Lung function was measured in 43 preterm infants with BPD and in 32 preterm infants without BPD at a chronological age range of 2-28 months. Forced vital capacity (FVC), forced expiratory volume at 0.5 sec, and forced expiratory flows at 50, 75, 85%, and 25-75% of FVC were obtained from maximal expiratory volume curves by means of rapid thoracic compression with raised volume technique. Maximal flow at functional residual capacity was measured using rapid thoracic compression at tidal volume. Multiple regression analysis and generalized least squares (GLS) random-effects regression model were used to control for variables such as gender, weeks of gestation, age, birth weight, and tobacco smoke exposure. A sub-analysis was performed in infants born at 28þ weeks of gestation. Results: BPD was associated to significantly lower flows (regression coefficients: À0.51, À0.54, À57, À0.53, and À0.82, respectively for FEF 50 , FEF 75 , FEF 85 , FEF 25-75). This association was driven by males and maintained in the subgroup of infants born at 28þ weeks of gestation. Conclusion: BPD is associated with an additional decrease of lung function during the first 2 years of life in infants born preterm. Pediatr Pulmonol.
BMC Pediatrics, 2012
Background: The pathogenesis of chronic lung disease of prematurity involves maturational arrest and neonatal lung disease (NLD) followed by mechanical ventilation (MV). However, the effect of these factors on postnatal lung function is not well established. Therefore, the aim of this study was to examine the differential effects of immaturity and NLD requiring MV on lung function test (LFT) parameters within 4 months after discharge. Patients and Methods: A total of 386 very low birth weight (VLBW) infants (birth weight <1,500 g) were examined at a median postmenstrual age of 49 weeks. Two hundred twenty-six infants (59%) were born before the 28th week of gestation, and 247 infants (64%) had NLD requiring invasive MV. LFTs included tidal breathing measurements, measurement of respiratory mechanics assessed by occlusion test, body plethysmography, SF6 multiple breath washout, forced expiratory flow (V 0 max FRC ) by rapid thoraco-abdominal compression technique, endexpiratory CO 2 (P et CO 2 ), exhaled NO (FeNO), and arterialized capillary blood gas analysis. Main Results: Multivariate analysis indicated that severe immaturity was mainly associated with changes in the breathing pattern (reduced tidal volume (P ¼ 0.003) and increased respiratory rate (P ¼ 0.03)), a reduced V 0 max FRC (P ¼ 0.004) and lower respiratory compliance (P < 0.001). NLD requiring MV, but not immaturity, was significantly and independently associated with increased respiratory and airway resistances (both P ¼ 0.003), reduced FRC SF6 (P ¼ 0.03), increased P et CO 2 (P ¼ 0.019) and lower FeNO (P < 0.001). Both immaturity and NLD requiring MV caused a lower paO 2 (P < 0.001) and higher a paCO 2 . Conclusions: Lung function after discharge of VLBW infants is differentially affected by both immaturity and NLD requiring MV. With increasing prematurity, intubated and mechanically ventilated infants are at increased risk of developing impaired lung function which can be detected by LFT. Pediatr Pulmonol. ß
Increased Respiratory Drive and Limited Adaptation to Loaded Breathing in Bronchopulmonary Dysplasia
Pediatric Research, 1992
Ventilatory parameters and respiratory drive function (3), much of the clinical success of these neonates must, with and without an added acute resistive load were astherefore, be due to the neonates' ability to adapt to the respirasessed in 11 healthy preterm infants and 11 infants with tory load offered by their abnormal pulmonary function. bronchopulmonary dysplasia (BPD). Lung mechanics A component of the respiratory adaptation is the infant's (breathing frequency, tidal volume, minute ventilation, respiratory center output. Changes in the respiratory center compliance, and resistance) were determined with esopha-output can be assessed by measuring the mouth pressure genergeal manometry and pneumotachography. Respiratory ated 0.1 s after an airway occlusion at end expiration (Ploo) (4drive was assessed by determining the airway pressure 6). The determination of the preterm neonate's respiratory center measured 100 ms after the onset of an inspiratory effort compensation for the chronic intrinsic respiratory load of BPD against an occlusion. Infants were studied at baseline and would help to clarify the apparent dichotomy in clinical and lung with an external inspiratory resistive load of 213.7 cm function improvement. H,O/L/s. Infants with BPD had similar breathing fre-It has been reported that healthy preterm infants respond to quency, tidal volume, and minute ventilation, lower com-the application of an acute respiratory load with an immediate pliance, and greater resistance and airway pressure at 100 decrease in MV and oxygen consumption with minimal disturbms than healthy preterm infants at rest. With loading, ances in arterial blood gas tensions (4,7,8). However, the ability healthy preterm infants demonstrated increased airway of healthy newborns to change their respiratory drive in response pressure at 100 ms, whereas infants with BPD showed no to resistive loads remains unclear. Duara et al. (4) observed no