Influence of sedation on the hering‐breuer inflation reflex in healthy infants

Rabbette, P. S.; Dezateux, Carol; Fletcher, M. E.; Costeloe, KL; Stocks, Janet

doi:10.1002/ppul.1950110307

Cited by 16 publications

(13 citation statements)

References 20 publications

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“…Chloral hydrate at doses of 60 -80 mg/kg is described as safe and with minimal alterations in gasometrical and pulmonary variables such as respiratory-system compliance, respiratory drive, and lung volumes. 17,[35][36][37] In a sedated infant, PSE could minimally interfere with respiratory variables, and during clinical practice it is not rare to treat sedated patients. We believe that the chloral hydrate did not affect these variables during our study.…”

Section: Discussionmentioning

confidence: 99%

Prolonged Slow Expiration Technique in Infants: Effects on Tidal Volume, Peak Expiratory Flow, and Expiratory Reserve Volume

et al. 2011

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BACKGROUND: Prolonged slow expiration (PSE) is a physiotherapy technique often applied in infants to reduce pulmonary obstruction and clear secretions, but there have been few studies of PSE's effects on the respiratory system. OBJECTIVE: To describe PSE's effects on respiratory mechanics in infants. METHODS: We conducted a cross-sectional study with 18 infants who had histories of recurrent wheezing. The infants were sedated for lung-function testing, which was followed by PSE. The PSE consisted of 3 sequences of prolonged manual thoraco-abdominal compressions during the expiratory phase. We measured peak expiratory flow (PEF), tidal volume (V T ), and the frequency of sighs during and immediately after PSE. We described the exhaled volume during PSE as a fraction of expiratory reserve volume (%ERV). We quantified ERV with the raised-volume rapid-thoracic-compression technique. RESULTS: The cohort's mean age was 32.2 weeks, and they had an average of 4.8 previous wheezing episodes. During PSE there was significant V T reduction (80 ؎ 17 mL vs 49 ؎ 11 mL, P < .001), no significant change in PEF (149 ؎ 32 mL/s vs 150 ؎ 32 mL/s, P ‫؍‬ .54), and more frequent sighs (40% vs 5%, P ‫؍‬ .03), compared to immediately after PSE. The exhaled volume increased in each PSE sequence (32 ؎ 18% of ERV, 41 ؎ 24% of ERV, and 53 ؎ 20% of ERV, P ‫؍‬ .03). CONCLUSIONS: It was possible to confirm and quantify that PSE deflates the lung to ERV. PSE caused no changes in PEF, induced sigh breaths, and decreased V T , which is probably the main mechanical feature for mucus clearance.

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Section: Discussionmentioning

confidence: 99%

Prolonged Slow Expiration Technique in Infants: Effects on Tidal Volume, Peak Expiratory Flow, and Expiratory Reserve Volume

et al. 2011

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“…Sedation was used in this study as most of the infants were aged w3 months and the tidal breathing measurements preceded more complex forced expiratory manoeuvres. Furthermore, chloral hydrate or triclofos, in the doses commonly used for infant lung function tests, appear to have minimal effect on either TPTEF:TE [6] or RR [29,30]. While poorer absorption of sedative could, theoretically, result in lighter sedation in infants with CF, this is unlikely to have influenced the results of the current study, since no differences were observed between the two groups with respect to the duration of sleep induced by sedation and recordings were limited to periods of quiet sleep and regular tidal breathing.…”

Section: Discussionmentioning

confidence: 99%

Assessment of tidal breathing parameters in infants with cystic fibrosis

Ranganathan¹,

Goetz²,

Hoo³

et al. 2003

Eur Respir J

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Simple methods are needed to assess lung function in infants with cystic fibrosis (CF). This study determined the relationship between simple measurements obtained from tidal breathing with those from more complicated forced expiratory manoeuvres.Healthy infants and infants with CF were recruited from two maternity units and five specialist CF hospitals, respectively. Respiratory rate, tidal volume, minute ventilation and the tidal breathing ratio (TPTEF:TE) were measured in sedated infants and compared with forced expiratory volume in 0.4 seconds (FEV0.4) measured by the raised volume technique.Altogether, 95 healthy infants and 47 infants with CF of similar age, sex, ethnicity and proportion exposed to maternal smoking were recruited. There was no difference in TPTEF:TE and tidal volume between healthy infants and those with CF. Minute ventilation was significantly greater in infants with CF due to a mean (95% confidence interval) increase in respiratory rate of 5.8 (3.2-8.4) min -1 . Thirteen (28%) infants with CF had a respiratory rate elevated by w2 SD. However, no association between respiratory rate and FEV0.4 could be identified.Tidal breathing ratio was not useful in identifying diminished airway function in infants with cystic fibrosis. An elevated respiratory rate may be due in part to ventilation heterogeneity but is poorly predictive of diminished airway function measured by forced expiration. Eur Respir J 2003; 22: 761-766.

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“…The effect of sedation on ventilation distribution inhomogeneity remains unclear, although values in healthy unsedated infants [26,30] are similar to the results reported here in sedated infants, despite different systems. Chloral hydrate sedation has been shown to have minimal effects on breathing patterns, strength of Hering-Breuer inflation reflex or oxygen saturation in healthy infants during the first 2 years of age [43,44].…”

Section: Paediatric Lung Functionmentioning

confidence: 99%

Age and height dependence of lung clearance index and functional residual capacity

Lum¹,

et al. 2012

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The lung clearance index (LCI) is more sensitive than spirometry in detecting abnormal lung function in children with cystic fibrosis. LCI is thought to be independent of age, but recent evidence suggests that the upper limit of normal is higher in infants and preschool children than in older subjects. This study examines whether LCI remains independent of body size throughout childhood.Multiple-breath washout data from healthy children and adolescents were collated from three centres using the mass spectrometer system and the inert gas sulfur hexafluoride. Reference equations for LCI and functional residual capacity (FRC) were constructed using the LMS (lambda-mu-sigma) method.Data were available from 497 subjects (2 weeks to 19 years of age) tested on 659 occasions. LCI was dependent on body size, decreasing in a nonlinear pattern as height increased. Changes were particularly marked in the first 5 years of life. Height, age and sex were all independent predictors of FRC. Minimal between-centre differences allowed unified reference equations to be developed.LCI is not independent of body size. Although a constant upper normal limit would suffice for cross-sectional clinical assessments from 6 years of age, appropriate reference equations are essential for accurate interpretation of results during early childhood. KEYWORDS: Children, functional residual capacity, lung clearance index, reference values, ventilation inhomogeneity M easuring the efficiency of ventilation distribution within the lung offers the exciting potential to detect early disease processes missed by conventional flow-based lung function techniques such as spirometry. Multiple-breath inert-gas washout (MBW) is a noninvasive tidal breathing test, feasible across all ages, which offers improved sensitivity, compared with spirometry, to detect early cystic fibrosis lung disease throughout childhood [1][2][3].It is generally thought that LCI is independent of body size. However, cross-sectional studies in infants have suggested that the upper limit of normal (ULN) for global measures of ventilation distribution inhomogeneity, such as lung clearance index (LCI), may be higher compared with older subjects [3,4]. Such differences, which could arise from developmental changes or differences in measurement conditions, may preclude identification of early lung disease in both cross-sectional and longitudinal studies. Furthermore, appropriate normative data for functional residual capacity (FRC) derived from MBW (FRCMBW) spanning the paediatric age range are lacking. The aim of this study was to investigate the relationship between body size and LCI from infancy to young adulthood, and establish reference equations for both LCI and FRCMBW across this age range. METHODSMBW was performed in healthy children at three specialised paediatric centres in the UK, Sweden and Canada as described previously [3,[5][6][7][8][9][10]. Briefly, during wash-in, a dry air mixture containing Gustafsson) and protocols in all centres [11]. Please see the online su...

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Influence of sedation on the hering‐breuer inflation reflex in healthy infants

Cited by 16 publications

References 20 publications

Prolonged Slow Expiration Technique in Infants: Effects on Tidal Volume, Peak Expiratory Flow, and Expiratory Reserve Volume

Prolonged Slow Expiration Technique in Infants: Effects on Tidal Volume, Peak Expiratory Flow, and Expiratory Reserve Volume

Assessment of tidal breathing parameters in infants with cystic fibrosis

Age and height dependence of lung clearance index and functional residual capacity

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