Assessment of bronchodilator response by forced oscillation technique in a preterm infant with evolving bronchopulmonary dysplasia: A case report

Abstract

Inhaled bronchodilators are often given in preterm infants with evolving or established bronchopulmonary dysplasia. However, it is unclear which patients may benefit from it and when it is the best time to start treatment. The forced oscillation technique (FOT) is a noninvasive method for assessing lung mechanics that proved sensitive to airway obstruction reversibility in children and adults. FOT does not need patient cooperation, which is ideal for infants. Bedside tools for applying FOT in infants during spontaneous breathing and different respiratory support modes are becoming available. This case report illustrates for the first time that FOT has potential value in assessing airway obstruction reversibility in preterm infants, informing which infants may manifest a clinical benefit from the treatment with bronchodilators.

Pediatric pulmonology year in review 2021 and 2022: Physiology

“…In a case report by Rigotti et al, 22 R10 and X10 were measured before and after inhaled albuterol at 40 weeks postmenstrual age in an infant born at 29 weeks gestation. R10 decreased and X10 increased (i.e., became less negative) significantly after albuterol treatment.…”

“…FO has been used to assess bronchodilator response (BDR) in older children and adults, but there are limited data on BDR in preterm infants. In a case report by Rigotti et al, 22 R10 and X10 were measured before and after inhaled albuterol at 40 weeks postmenstrual age in an infant born at 29 weeks gestation. R10 decreased and X10 increased (i.e., became less negative) significantly after albuterol treatment.…”

Respiratory support strategies in the prevention and treatment of bronchopulmonary dysplasia

“…In cases where esophageal manometry is not feasible or not available, measuring static respiratory mechanics using an expiratory hold can identify the severity of PEEPi, and an inspiratory hold at increasing leveles of PEEP, often called a "PEEP grid," can determine the PEEP that optimizes respiratory system compliance and resistance, which is generally ideal for chronic respiratory support (62, 63). Forced oscillation technique (FOT) can also be used to objectively measure respiratory system resistance and reactance in neonate with BPD and is becoming increasingly available; thus, FOT could prove useful when titrating PEEP as well as measuring response to other interventions (64).…”

Oscillatory mechanics in very preterm infants on continuous positive airway pressure support: Reference values

“…Zrs is commonly expressed in terms of respiratory system resistance (Rrs) and reactance (Xrs), which in turn represents the elastic and inertive properties of the system. Xrs proved sensitive to neonatal lung disease and was useful in prognosticating respiratory outcomes, 3,4 optimizing respiratory support, 5,6 evaluating the need for and the response to pulmonary medications, 7,8 and objectivizing respiratory outcomes 9 in preterm infants.…”