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

Klinger, Andrew; Travers, Colm P.; Martin, Abigail E.; Kuo, Hui-Chien; Alishlash, Ammar Saadoon; Harris, William T.; Carlo, Waldemar A.; Ambalavanan, Namasivayam

doi:10.1038/s41390-020-0751-7

Cited by 17 publications

(14 citation statements)

References 32 publications

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“…The FOT-PFT findings are especially relevant to modern neonatology. Forced oscillation lung function testing is becoming available for clinical use in neonates and can discriminate between healthy infants and those with pulmonary conditions such as transient tachypnea of the neonate (18). While not readily available, infant FOT would allow clinicians to evaluate the response of infants to respiratory therapy and identify those in need of additional treatment.…”

Section: Resultsmentioning

confidence: 99%

Intratracheal budesonide/surfactant attenuates hyperoxia-induced lung injury in preterm rabbits

Gie

Regin

Salaets

et al. 2020

American Journal of Physiology-Lung Cellular and Molecular Phys

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Recent clinical trials have shown improvements in neonatal outcomes after intratracheal administration of combination budesonide/surfactant (ITBS)in infants at risk of bronchopulmonary dysplasia. However, the effect of ITBSon lung function and alveolar structure is not known. We aimed to determine the effect of ITBSon lung function, parenchymal structure and inflammatory cytokine expression in a relevant preterm animal model for bronchopulmonary dysplasia. Premature neonatal rabbits were administered a single dose of ITBSon the day of delivery and exposed to 95% oxygen. Following seven days of hyperoxia,in vivoforced oscillation and pressure-volume maneuvers were performed to examine pulmonary function. Histological and molecular analysis was performed to assess alveolar and extracellular matrix (ECM) morphology, along with gene expression of connective tissue growth factor (CTGF), IL-8 and CCL-2. ITBS attenuated the functional effect of hyperoxia-induced lung injury and limited the change to respiratory system impedance, measured using the forced oscillation technique. Treatment effects were most obvious in the small airways, with significant effects on small airway resistance and reactance. Additionally, ITBS mitigated the decrease of inspiratory capacity and static compliance. ITBS restricted alveolar septal thickening without altering the mean linear intercept and mitigated hyperoxia-induced remodeling of the ECM. These structural changes were associated with improved inspiratory capacity and lung compliance. Gene expression of CTGF IL-8 and CCL-2 were significantly down regulated in the lung. Treatment with ITBS shortly after delivery attenuated the functional and structural consequences of hyperoxia-induced lung injury to day 7 of life in the preterm rabbit.

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Section: Resultsmentioning

confidence: 99%

Intratracheal budesonide/surfactant attenuates hyperoxia-induced lung injury in preterm rabbits

Gie

Regin

Salaets

et al. 2020

American Journal of Physiology-Lung Cellular and Molecular Phys

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“…It therefore remains unclear whether our results are generalizable to much younger children with NMDs, although we expect this to be the case as FOT has been shown to allow for evaluations of respiratory mechanics in neonates and very young children. FOT is able to distinguish between healthy neonates and neonates with respiratory problems 6 .…”

Section: Discussionmentioning

confidence: 99%

Forced Oscillation Technique: a surrogate measure of lung function in neuromuscular disease patients?

Veldhoen

Roos

Bekkema

et al. 2022

Preprint

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Introduction Spirometry plays an important role in the assessment of possible respiratory failure in children with neuromuscular disorders (NMDs). However, obtaining reliable spirometry results is a major challenge. We studied the relation between Forced Oscillation Technique (FOT) and spirometry results. FOT is an easy, non-invasive method to measure respiratory mechanics, i.e. respiratory resistance R and respiratory reactance X. We hypothesized an increased resistance R and reduced reactance X in patients with more reduced lung function. Methods In this prospective single center study we included all children with NMDs able to perform spirometry. We consecutively measured respiratory resistance R and reactance X at 5, 11 and 19 Hz and (Forced) Vital Capacity, Peak Expiratory Flow. Spearman correlation coefficients were calculated and regression curves were estimated. Results We included 148 patients, with a median age of 13 years (IQR 8-16). All correlation coefficients were statistically significant with p = 0.000. A negative correlation was found between resistance R and spirometry outcomes (spearman correlation coefficient (ρ) between -0.5 and -0.6). A positive correlation was found between reactance X (i.e. less negative outcomes) and spirometry outcomes (ρ between 0.4 and 0.6). Highest correlation was found at lower frequencies. Regression analysis showed a non-linear relation between FOT and spirometry results. Conclusion We found a non-linear relation between FOT and spirometry results with increased resistance R and reduced reactance X in patients with more restrictive lung function decline. Given the difficulties with performing spirometry, FOT may be a promising surrogate measure of lung function.

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“…An important point to remember with oscillometry (preclinical and clinical) is that the measurements generally include a contribution from the chest walls, unless an additional pressure transducer is added to capture the intrapleural pressure or that the experimental (preclinical) conditions include an open chest. In addition, as the lung develops and grows, variations in the shape of the impedance spectra can be seen (Figure 2), reflecting the maturation of the respiratory system, sometimes very quickly such as right after birth (21,104). Also, as discussed in the following sections, the specific contribution of the various components of the respiratory system can vary across different health or disease conditions.…”

Section: Oscillometry Of the Normal And Diseased Lung Physiological Correlationsmentioning

confidence: 99%

“…In addition, as the lung develops and grows, variations in the shape of the impedance spectra can be seen ( Fig. 2 ), reflecting the maturation of the respiratory system, sometimes very quickly such as right after birth ( 111 , 112 ). Also, as discussed in the following sections, the specific contribution of the various components of the respiratory system can vary across different health or disease conditions.…”

Section: Oscillometry Of the Normal And Diseased Lungmentioning

confidence: 99%

“…With almost all novel therapies being tested aiming at pathologies affecting the lung periphery, it would not be surprising to see oscillometry displaying an edge over spirometry in most studies. Similarly, in clinical practice, it seems that oscillometry is challenging the standard technique in pulmonary care, especially in pediatric patients ( 112 , 207 ). Its ease of use and the absence of a forced maneuver may also promote it in the adult population, as exemplified with ACR in lung transplantation above, where the superior sensitivity of oscillometry should make it universally adopted for monitoring lung transplant patients for diagnosis but also to confirm treatment effects ( 183 ).…”

Section: Moving Forwardmentioning

confidence: 99%

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Oscillometry of the respiratory system: a translational opportunity not to be missed

Lundblad

Robichaud²

2021

American Journal of Physiology-Lung Cellular and Molecular Phys

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Airway oscillometry has become the de facto standard for quality assessment of lung physiology in laboratory animals and has demonstrated its usefulness in understanding diseases of small airways. Nowadays, it is seeing extensive use in daily clinical practice and research, however, a question that remains unanswered is how well physiological findings in animals and humans correlate? Methodological and device differences are obvious between animal and human studies. However, all devices deliver an oscillated airflow test signal and output respiratory impedance. In addition, despite analysis differences, there are ways to interpret animal and human oscillometry data to allow suitable comparisons. The potential with oscillometry is its ability to reveal universal features of the respiratory system across species, making translational extrapolation likely to be predictive. This means that oscillometry can thus help determine if an animal model displays the same physiological characteristics as the human disease. Perhaps more importantly, it can also be useful to determine whether an intervention is effective as well as to understand if it affects the desired region of the respiratory system e.g., the periphery of the lung. Finally, findings in humans can also inform preclinical scientists and give indications as to what type of physiological changes should be observed in animal models to make them relevant as models of human disease. The present article will attempt to demonstrate the potential of oscillometry in respiratory research, an area where the development of novel therapies is plagued with a failure rate higher than in other disease areas.

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

Cited by 17 publications

References 32 publications

Intratracheal budesonide/surfactant attenuates hyperoxia-induced lung injury in preterm rabbits

Intratracheal budesonide/surfactant attenuates hyperoxia-induced lung injury in preterm rabbits

Forced Oscillation Technique: a surrogate measure of lung function in neuromuscular disease patients?

Oscillometry of the respiratory system: a translational opportunity not to be missed

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