(Spon. by L.J. Butterfield). The pressure in an infant's airway when CPAP is delivered by nasal prongs has not been previously repor ted. Using air-filled catheters and differential pres sure transducers we have measured simultaneous pressures in nasal prongs (Ppr) and pharynx(Ppx) in 1 8 newborns. After a steady state was achieved, end expi ratory pressure in five consecutive breaths was measured: these were usually identical but otherwise were averaged. The pressure difference (Ppr-PpXsAP) was lo in infants with visual evidence of tight palato-glossal apposition. Though there was much variation, babies whose mouths were a) spontaneously open without tonguelpalate seal had a %AP=48% + 4% (weighted average + SEM), b) spontaneously closed or who had a demonstrable seal had a %AP-8% 2 3%; these are significantly different means (p=<.001). In the latter group there was a close correlation between P p r and Ppx (r-0.965). The ability to maintain a good seal was not related to gestational age, post natal a g e , severity or type of disease. However, babies who maintained a good seal frequently had an active gag reflex (Fisher exact test p=.04). Spontaneous closure o f the mouth usually indicated a good seal but forcible closure di rut r o n q l q t p n t l v A~r r a * c -~m~a m m e r s m l t n H o s p~t a l m e e n hllzabeth osp ta for Children, London. England. . -Godfrey and Mearns have shown that exercise intolerance in children with C.F. is related to airway obstruction. Recently Campbell et a1 suggested that poor nutrition leads to abnormal serum lipids which may lead to tissue hypoxia. Our study investigated the roles of hypoxia, lung mechanics, nutritional status and serum lipids in limiting exercise tolerance. Twenty children with C.F. of varying severity performed two progressive exercise tests on a cycle ergometer, once breathing air, once 02. The body mass percentile,(EMP), as a measure of appropriateness of weight for height, was calculated from the body mass index.Serum lipids, maximal mid-expiratory flow rate (MMT) and maximum voluntary ventilation were measured. In five, end tidal C02 (PETC02) was monitored throughout the test. 0 had very little effect on the work accomplished by each child. '?he mean percent work expected from height (Wmax) was 75 and the heart rate at the final work load was 175/min.,20 less in normal children suggesting adequate car3iovascular reserve at the final work load. Wmax correlated with the MMF,the BMP and the Shwachman score. The children with the lower MMF's had little respiratory reserve at the final work load. Despite this,no child at any time had an elevated PETCO .jerum lipids,while abnormal in every case,did not correlate with ny parameter measured.We conclude that nutritional status and C irway obstruction are closely correlated with exercise tolerance n C.F. and that,unlike the adult with chronic disease,exercise imiting dyspnea occurs with a normal PETC02. Fetal lung maturation is typified by independent increases in both lecithin (TL) and disaturated lecithin (DS...
To test the influence of head posItion on pulmonary function in tetraplegic individuals 15 subjects with chronic C 4 -C 7 injuries participated in a one group pre-post test comparing the relationship between orthostatic position of the head (OPH) and standard pulmonary function tests (PFTs). Twelve subjects with habitual forward head posture and three with non-forward head posture performed PFTs in (I) their habitual posture, and (2) an experimental posture imposed by placement of thoracic and/or lumbar rolls behind their back. Results showed that changing head posture did not alter mid-forced expiratory flow or forced inspiratory vital capacity, but significantly affected rorced vital capacity ( t = 2. 83; P<0.05) and 12 s maximum voluntary ventilation (t = 2.07; P < 0,05). In cases where pulmonary function was altered by head position, the resulting performance was best in the subject's habitual posture, although no differences in resting pulmonary tests were observed between subjects with and without forward head position. These data show that temporary postural alterations affecting OPH, if not allowing sufficient time for muscular adaptation, adversely affect pulmonary function in tetraplegic patients,
Chest physical therapy for neonates with pulmonary dysfunction is a growing specialty of physical therapy practice. The purpose of this article is to provide physical therapists current information regarding chest physical therapy for the newborn infant. The neonatal diagnoses for which chest physical therapy is useful or has good rationale are discussed. Common complications are reviewed that affect physical therapy and medical treatment for infants with respiratory diseases and prematurity. Specific indications, contraindications, and precautions for physical therapy techniques are listed. Chest physical therapy evaluation and treatment are described and rationale for the application of various techniques is provided. Literature is reviewed dealing with the effects of chest physical therapy on neonates with pulmonary dysfunction. The strengths and weaknesses of each reviewed study are analyzed and suggestions for direction of future research for physical therapists are provided.
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