Forced oscillation measurements in the first week of life and pulmonary outcome in very preterm infants on noninvasive respiratory support

Zannin, Emanuela; Neumann, Roland; Dellacà, Raffaele L.; Schulzke, Sven

doi:10.1038/s41390-019-0432-6

Cited by 15 publications

(23 citation statements)

References 20 publications

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“…We (15,27,34) have previously demonstrated with EIT that lung aeration occurs exponentially during a SI at birth. In the present study, we have shown that the C x5 time course signal mirrors that of V LEIT , confirming that C x5 reflects the total amount of aerated lung (3,6,38) and demonstrating that C x5 can be used not only to monitor lung volume recruitment during PPV (5,22,35,37,39) but also to define the physiological process of distal lung aeration at birth.…”

Section: Discussionsupporting

confidence: 79%

Respiratory mechanics during initial lung aeration at birth in the preterm lamb

Veneroni

Tingay

McCall

et al. 2020

American Journal of Physiology-Lung Cellular and Molecular Phys

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Despite recent insights into the dynamic processes during lung aeration at birth, several aspects remain poorly understood. We aimed to characterize changes in lung mechanics during the first inflation at birth and their relationship to changes in lung volume. Intubated preterm lambs (gestational age, 124–127 days; n = 17) were studied at birth. Lung volume changes were measured by electrical impedance tomography (VL EIT). Respiratory system resistance (R5) and oscillatory compliance (Cx5) were monitored with the forced oscillation technique at 5 Hz. Lambs received 3–7 s of 8 cmH2O of continuous distending pressure (CDP) before delivery of a sustained inflation (SI) of 40 cmH2O. The SI was then applied until either Cx5 or the VL EIT or the airway opening volume was stable. CDP was resumed for 3–7 s before commencement of mechanical ventilation. The exponential increases with time of Cx5 and VL EIT from commencement of the SI were characterized by estimating their time constants (τCx5 and τVL EIT, respectively). During SI, a fast decrease in R5 and an exponential increase in Cx5 and VL EIT were observed. Cx5 and VL EIT provided comparable information on the dynamics of lung aeration in all lambs, with τCx5 and τVL EIT being highly linearly correlated ( r2 = 0.87, P < 0.001). Cx5 and VL EIT decreased immediately after SI. Despite the standardization of the animal model, changes in Cx5 and R5 both during and after SI were highly variable. Lung aeration at birth is characterized by a fast reduction in resistance and a slower increase in oscillatory compliance, the latter being a direct reflection of the amount of lung aeration.

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Section: Discussionsupporting

confidence: 79%

Respiratory mechanics during initial lung aeration at birth in the preterm lamb

Veneroni

Tingay

McCall

et al. 2020

American Journal of Physiology-Lung Cellular and Molecular Phys

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“…The technique does not involve estimating the pleural pressure by positioning an oesophagal balloon or evoking the Hering–Breuer inflation reflex for respiratory muscle relaxation. Previous studies demonstrated FOT feasibility in the delivery room [ 31 ] and the NICU, both in intubated patients [ 27 – 29 ] and infants receiving NCPAP [ 30 ]. Moreover, thanks to recent technological advancements, oscillometry can be now integrated into modern mechanical ventilators.…”

Section: Discussionmentioning

confidence: 99%

“…In particular, studies demonstrated that the total respiratory system reactance (Xrs) measured at frequencies lower than 10 Hz at a given distending pressure is a sensitive and specific indicator of lung volume recruitment [ 19 , 24 ]. FOT measurements are suitable at the bedside in preterm infants during invasive [ 25 – 29 ] and non-invasive respiratory support [ 30 ], and even during respiratory stabilization in the delivery room [ 31 ]. Moreover, oscillometry assessments in the first few days of life can predict respiratory support duration [ 27 , 30 ].…”

Section: Introductionmentioning

confidence: 99%

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Oscillatory mechanics at birth for identifying infants requiring surfactant: a prospective, observational trial

et al. 2021

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Background Current criteria for surfactant administration assume that hypoxia is a direct marker of lung-volume de-recruitment. We first introduced an early, non-invasive assessment of lung mechanics by the Forced Oscillation Technique (FOT) and evaluated its role in predicting the need for surfactant therapy. Objectives To evaluate whether lung reactance (Xrs) assessment by FOT within 2 h of birth identifies infants who would need surfactant within 24 h; to eventually determine Xrs performance and a cut-off value for early detection of infants requiring surfactant. Methods We conducted a prospective, observational, non-randomized study in our tertiary NICU in Milan. Eligible infants were born between 27+0 and 34+6 weeks’ gestation, presenting respiratory distress after birth. Exclusion criteria: endotracheal intubation at birth, major malformations participation in other interventional trials, parental consent denied. We assessed Xrs during nasal CPAP at 5 cmH2O at 10 Hz within 2 h of life, recording flow and pressure tracing through a Fabian Ventilator for off-line analysis. Clinicians were blinded to FOT results. Results We enrolled 61 infants, with a median [IQR] gestational age of 31.9 [30.3; 32.9] weeks and birth weight 1490 [1230; 1816] g; 2 infants were excluded from the analysis for set-up malfunctioning. 14/59 infants received surfactant within 24 h. Xrs predicted surfactant need with a cut-off − 33.4 cmH2O*s/L and AUC-ROC = 0.86 (0.76–0.96), with sensitivity 0.85 and specificity 0.83. An Xrs cut-off value of − 23.3 cmH2O*s/L identified infants needing surfactant or respiratory support > 28 days with AUC-ROC = 0.89 (0.81–0.97), sensitivity 0.86 and specificity 0.77. Interestingly, 12 infants with Xrs < − 23.3 cmH2O*s/L (i.e. de-recruited lungs) did not receive surfactant and subsequently required prolonged respiratory support. Conclusion Xrs assessed within 2 h of life predicts surfactant need and respiratory support duration in preterm infants. The possible role of Xrs in improving the individualization of respiratory management in preterm infants deserves further investigation.

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“…Previous FOT studies have used a very limited range of non-prime frequencies, which may not offer the same information on underlying respiratory mechanics in the neonatal population, or used custom built FOT devices ( 15 , 18 ). Additionally, other neonatal FOT studies have used respiratory pauses by evoking the Hering-Breuer inflation reflex during oscillometry ( 19 , 20 ) rather than evaluate FOT during quiet breathing, have evaluated only sedated infants ( 21 ), or evaluated premature neonates ( 22 ).…”

Section: Discussionmentioning

confidence: 99%

Non-invasive forced oscillometry to quantify respiratory mechanics in term neonates

et al. 2020

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Objective: Determine normative data by forced oscillation technique (FOT) in non-sedated normal term neonates and test the hypothesis that infants with transient tachypnea of the newborn (TTN) have higher resistance (R) and lower reactance (X) on day 1. Methods: Healthy term infants (n=138) and infants with TTN (n = 17) were evaluated on postnatal days 1 through 3 (NCT03346343). FOT was measured with a mask using a TremoFlo C-100 Airwave System™. R, X, and area under the reactance curve (AX) were measured at prime frequencies 7 to 41 Hz for 8s. Results: 86% of control infants had adequate measurements (coherence >0.8, CV < 0.25) on day 1. Infants with TTN had higher resistance at 13 Hz (TTN 32.5 cmH 2 O·s/L [95% CI 25.5–39.4]; controls 23.8 cmH 2 O·s/L [95% CI 22.2–25.3], P = 0.007) and lower reactance from 17 – 37 Hz (TTN −35.1 to −10.5; controls −26.3 to −6.1, P<0.05). In healthy controls, lung mechanics were unchanged from days 1–3. In TTN, lung mechanics normalized on days 2 and 3. Conclusions: FOT is feasible in neonates and distinguishes normal control infants from those with TTN on postnatal day 1. Oscillometry offers a non-invasive, longitudinal technique to assess lung mechanics in newborns. Trial Registration: Clinicaltrials.gov Identifier

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Forced oscillation measurements in the first week of life and pulmonary outcome in very preterm infants on noninvasive respiratory support

Cited by 15 publications

References 20 publications

Respiratory mechanics during initial lung aeration at birth in the preterm lamb

Respiratory mechanics during initial lung aeration at birth in the preterm lamb

Oscillatory mechanics at birth for identifying infants requiring surfactant: a prospective, observational trial

Non-invasive forced oscillometry to quantify respiratory mechanics in term neonates

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