To investigate the influence of nonlinearities on estimates of respiratory mechanics, differing patterns of mechanical ventilation patterns were analyzed from 8 puppies and 14 children. Respiratory mechanics were calculated using multiple linear regression to fit a linear single-compartment model, a volume-dependent single-compartment model (VDSCM), and a flow-dependent single-compartment model. The ratio of the compliance of the last 20% of the dynamic volume-pressure (V-P) curve to the total compliance (C20/C) and the contribution of a volume-dependent elastance to total elastance [%E2 = E2 (VT)/[(E1 + E2)VT], where E1 + E2 is total elastance, E2 is the volume-dependent component, and VT is tidal volume] were used as the indexes of over-distension. By positioning the dynamic loops on the static V-P curves, ventilation patterns were classified as overdistended or nonoverdistended. In the overdistended group, the C20/C was significantly lower (0.71 +/- 0.10 vs. 0.92 +/- 0.16; P < 0.0001) and %E2 was significantly higher (43.4 +/- 15.0 vs. 0.51 +/- 18.02%, P < 0.0001) than in the nonoverdistended group. The mode of ventilation (pressure controlled vs. volume controlled) and the resistive pressures that resulted in widening of the dynamic V-P loop were found to alter C20/C but not %E2. When the respiratory system was overdistended, i.e., ventilated up to the flattened portion of the V-P curve, the VDSCM gave more accurate estimates of respiratory mechanisms. Furthermore, %E2 calculated from VDSCM is a useful parameter for estimating respiratory system overdistension that is not affected by resistive pressures.

Measurements of respiratory mechanics are frequently made in ventilated infants and children. Esophageal pressure measurements (Pes) using a balloon on a catheter have been used to partition the respiratory mechanics into lung and chest wall components. Appropriate positioning of this balloon is crucial to obtain accurate estimates of pleural pressure. Traditionally, in spontaneously breathing subjects the balloon position is assessed with an occlusion test. In ventilated subjects, it is not always possible to perform an occlusion test prior to paralysis, and even if such a test is performed it may be relevant under conditions of positive pressure ventilation. By occluding the airway opening and applying gentle pressure to the abdomen or rib cage, positive swings in pressure can be measured by both Pes and airway opening pressure (Pao). We compared traditional occlusion tests measured in 16 spontaneously breathing puppies to the positive pressure occlusion test performed after paralysis. In 2 pups we were unable to obtain a reasonable traditional occlusion test (> 15% difference between Pes and Pao) but we obtained 10 traditional occlusion tests in each of the remaining 14 pups (2.1-14 kg). In 11 of these animals delta Pes was within 10% of delta Pao. This compared well to positive pressure occlusion test using abdominal pressure performed after analysis, where delta Pes was within 10% of delta Pao in 10 animals. In 9 of these pups occlusion tests were also performed by applying pressure on the rib cage, where delta Pes was within 10% of delta Pao in 6 animals.(ABSTRACT TRUNCATED AT 250 WORDS)

Wheezy infants, less than 6 months of age, were given either inhaled salbutamol or saline in a double-blind study. A significant change in maximal flow at functional residual capacity (VmaxFRC) was defined as being greater than twice the coefficient of variation of the baseline measurements. There was no difference in the infants' response to saline or salbutamol. Wheezy infants, less than 6 months of age, do not have an increase in VmaxFRC following a single dose of inhaled salbutamol.

A cross-sectional survey involving 51 children, ranging in age from 3 wk to 15 yr, was performed to examine the changes in respiratory mechanics with age in mechanically ventilated children, using both a single-compartment model of the respiratory system and a more sophisticated two-compartment model. Children were studied while under anesthesia for urological surgery and were considered to have normal lungs. They were paralyzed and mechanically ventilated throughout measurements. Respiratory mechanics were measured during ventilation by applying a single-compartment model and by using multilinear regression to calculate dynamic compliance and respiratory system resistance (Rrs). We then used the interrupter technique, which allowed us to partition Rrs into airway resistance and a tissue viscoelastic component known as Pdif. A static volume-pressure curve was constructed from multiple occlusions made at different lung volumes throughout expiration, and static compliance was determined. Rrs and airway resistance decreased as height increased. There was a progressive increase in respiratory system compliance with height. Pdif fell in the first 2 yr of life and then subsequently increased after the age of approximately 5 yr.

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