Alleviating mechanical constraints to ventilation with heliox improves exercise endurance in adult survivors of very preterm birth

Duke, Joseph W.; Zidron, Amy; Gladstone, Igor M.; Lovering, Andrew T.

doi:10.1136/thoraxjnl-2018-212346

Cited by 11 publications

(21 citation statements)

References 12 publications

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“…Physical properties governing airflow include lung size, driving pressure and resistance. Previous work has noted no differences in lung volumes/capacities between adults born preterm and term-born controls when appropriately matched for sex and height (Halvorsen et al 2004;Vrijlandt et al 2006;Narang et al 2009;Lovering et al 2013Lovering et al , 2014Clemm et al 2014;Duke et al 2014Duke et al , 2018Duke et al , 2019Vollsaeter et al 2015;Farrell et al 2015;Caskey et al 2016;Laurie et al 2018;Molgat-Seon et al 2019;Huckstep et al 2020). Thus, lower pulmonary function is likely the result of interactions between impaired expiratory driving pressure and increased airway resistance, as discussed below.…”

Section: Respiratory Limitations To Exercisementioning

confidence: 91%

“…an end-expiratory lung volume that is ≥0.5 l greater than functional residual capacity. This breathing strategy is common in patients with severe COPD (Aliverti et al 2004;Eves et al 2006;Guenette et al 2012;Louvaris et al 2012), but is less so (∼1 in 10 participants) in adults born preterm (Lovering et al 2014;Duke et al 2018Duke et al , 2019. To date, the mechanical work of breathing has not been measured in adults born preterm, but the presence of one or more mechanical ventilatory constraint would result in an excessive work of breathing for a given ventilation.…”

Section: Mechanical Ventilatory Constraintsmentioning

confidence: 99%

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Physiological aspects of cardiopulmonary dysanapsis on exercise in adults born preterm

Duke

Lewandowski

Lovering

2022

The Journal of Physiology

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Section: Respiratory Limitations To Exercisementioning

confidence: 91%

Section: Mechanical Ventilatory Constraintsmentioning

confidence: 99%

Physiological aspects of cardiopulmonary dysanapsis on exercise in adults born preterm

Duke

Lewandowski

Lovering

2022

The Journal of Physiology

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“…Heliox has been found to have unique advantages in the treatment of respiratory diseases. With the physical characteristic of low density, heliox makes it easier for oxygen to pass through the airway lumen narrowed due to inflammation in infants, which can effectively reduce respiratory resistance, increase the blood oxygen content and improve respiratory system symptoms in infants 11–16 . Another potential benefit of helium is its anti‐inflammatory properties 17 .…”

Section: Introductionmentioning

confidence: 99%

A randomized single‐center controlled trial of synchronized intermittent mandatory ventilation with heliox in newborn infants with meconium aspiration syndrome

Tang²,

Shen

et al. 2021

Pediatric Pulmonology

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Objective This study aimed to investigate the beneficial effects of synchronized intermittent mandatory ventilation (SIMV) with heliox in newborn infants with meconium aspiration syndrome (MAS). Methods Seventy‐one newborn infants with MAS in the neonatal intensive care unit (NICU) of Daping Hospital of Army Medical University were enrolled in the trial. Infants treated with SIMV were randomized and divided into the heliox group (n = 35) and control group (n = 36). The heliox group received heliox for 6 h followed by air‐oxygen mixed gas, and the control group received air‐oxygen mixed gas. The primary outcome measures were PaO2/FiO2 (P/F) and the extubation time. The secondary outcome measures were the incidence of mechanical ventilation complications, hospital length of stay in the NICU, blood gas analysis, and inflammation markers. Results The P/F in the heliox group was significantly better than that in the control group (p < .001). The extubation time and hospital length of stay in the NICU in the heliox group were shorter than those in the control group (p < .001). The inflammation markers at 6 h and myocardial injury markers at 24 h were decreased compared with those at 0 h, and those in the heliox group were more significantly decreased than those in the control group ([interleukin {IL}‐6/IL‐8/tumor necrosis factor α] p < .001, [C‐reaction protein] p = .012; [creatine kinase] p < .001, [CK‐MB] p = .041). Conclusion Heliox appears to be more effective in reducing the length of ventilation and increasing carbon dioxide eliminations than an air‐oxygen mixture in infants with MAS under the support of SIMV.

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“…The heliox MEFV curves were generated in an identical manner described above. Helium has a lower density than nitrogen, thereby promoting laminar flow and decreasing airflow resistance (2,6,10,13,35). If high airflow resistance contributed to SR in PRE/BPD individuals, then breathing heliox during a forced expiratory maneuver would alter SR.…”

Section: Methodsmentioning

confidence: 99%

Analysis of maximal expiratory flow-volume curves in adult survivors of preterm birth

Molgat‐Seon

Dominelli

Peters

et al. 2019

American Journal of Physiology-Regulatory, Integrative and Comp

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Adult survivors of very preterm (≤32 wk gestational age) birth without (PRE) and with bronchopulmonary dysplasia (BPD) have variable degrees of airflow obstruction at rest. Assessment of the shape of the maximal expiratory flow-volume (MEFV) curve in PRE and BPD may provide information concerning their unique pattern of airflow obstruction. The purposes of the present study were to 1) quantitatively assess the shape of the MEFV curve in PRE, BPD, and healthy adults born at full-term (CON), 2) identify where along the MEFV curve differences in shape existed between groups, and 3) determine the association between an index of MEFV curve shape and characteristics of preterm birth (i.e., gestational age, mass at birth, duration of oxygen therapy) in PRE and BPD. To do so, we calculated the average slope ratio (SR) throughout the effort-independent portion of the MEFV curve and at increments of 5% of forced vital capacity (FVC) between 20 and 80% of FVC in PRE ( n = 19), BPD ( n = 25), and CON ( n = 20). We found that average SR was significantly higher in PRE (1.34 ± 0.35) and BPD (1.33 ± 0.45) compared with CON (1.03 ± 0.22; both P < 0.05) but similar between PRE and BPD ( P = 0.99). Differences in SR between groups occurred early in expiration (i.e., 20–30% of FVC). There was no association between SR and characteristics of preterm birth in PRE and BPD groups (all P > 0.05). The mechanism(s) of increased SR during early expiration in PRE/BPD relative to CON is unknown but may be due to differences in the structural and mechanical properties of the airways.

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Alleviating mechanical constraints to ventilation with heliox improves exercise endurance in adult survivors of very preterm birth

Cited by 11 publications

References 12 publications

Physiological aspects of cardiopulmonary dysanapsis on exercise in adults born preterm

Physiological aspects of cardiopulmonary dysanapsis on exercise in adults born preterm

A randomized single‐center controlled trial of synchronized intermittent mandatory ventilation with heliox in newborn infants with meconium aspiration syndrome

Analysis of maximal expiratory flow-volume curves in adult survivors of preterm birth

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