Oxygen cost of breathing in newborn infants with long-term ventilatory support

Rozé, Jean‐Christophe; Chambille, B; Fleury, Marie Anne; Debillon, Thierry; Gaultier, Claude

doi:10.1016/s0022-3476(95)70044-7

Cited by 19 publications

(11 citation statements)

References 11 publications

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“…In the normal OCB group V 'O 2 did not vary significantly. The V'O 2 increase was correlated with the increase in spontaneous ventilation (r 2 = 0.19, F [1,26] = 5.94; p<0.03). The percentage of spontaneous ventilation increased from 2% during PTV to 75% during SIMV and 100% during CPAP (p<0.001).…”

Section: Resultsmentioning

confidence: 94%

“…Eur Respir J 1997; 10: 2583-2585 Weaning from artificial ventilation is a critical challenge, especially in newborn infants with chronic lung disease. We have previously shown that these newborn infants increase their oxygen consumption (V'O 2 ) at the time of being weaned from mechanical ventilation [1]. This increase is secondary to a high oxygen cost of breathing (OCB) probably related to increased work of breathing, similar to that shown in adult patients [2].…”

mentioning

confidence: 78%

“…V 'O 2 and carbon dioxide production (V 'CO 2 ) were measured with a validated thermoregulated (38±0.5°C) computerized device [1,8]. The equations used were those of the open circuit method, including inspiratory fraction of carbon dioxide (FICO 2 ).…”

Section: Methodsmentioning

confidence: 99%

“…We considered OCB as normal when <15%. This value was chosen with regard to our previous report [1] in which OCB was 4.8±4.9% in a population of neonates who had been weaned without difficulty. The 16 infants were divided into normal or high OCB groups according to whether OCB was less or more than 15%.…”

Section: Methodsmentioning

confidence: 99%

“…The number of patients needed to show a V'O 2 difference between CPAP and PTV more than 2 mL·min -1 ·kg -1 in infants with high OCB, as well as to set the probability of a type 1 error at 0.05 and a type 2 error at 0.20, was determinated on the basis of data from our previous report [1]. It was calculated to be seven in the high OCB group (each patient being his or her own control).…”

Section: Methodsmentioning

confidence: 99%

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Oxygen cost of breathing and weaning process in newborn infants

Rozé¹,

Liet²,

Gournay³

et al. 1997

Eur Respir J

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Newborn infants may have a high oxygen cost of breathing (OCB) at the time of being weaned from mechanical ventilation. We hypothesized that this increase in oxygen consumption (V'O 2 ) could be reduced by using certain weaning ventilatory modes.We designed a study to assess V'O 2 during three weaning ventilatory modes: patient triggered ventilation, synchronous intermittent mandatory ventilation (SIMV) and continuous positive airway pressure in 16 newborn infants before being weaned from mechanical ventilation In seven infants whose OCB was high. V 'O 2 was not significantly different between CV and PTV (8.9±0.6 versus 9.5±0.8, respectively) whereas it tended to increase to 10.8±1.1 mL·min -1 ·kg -1 during SIMV and increased significantly to 11.9±0.8 mL·min -1 ·kg -1 . In the other nine infants whose OCB was normal, no significant variation of V 'O 2 was observed.Patient triggered ventilation was a weaning ventilatory mode that significantly reduced the increase in oxygen consumption observed in infants with a high oxygen cost of breathing, as compared to synchronous intermittent mandatory ventilation or continuous positive airway pressure. Further investigations in newborn infants with a high oxygen cost of breathing should be performed prior to routine use of patient triggered ventilation. Eur Respir J 1997; 10: 2583-2585 Weaning from artificial ventilation is a critical challenge, especially in newborn infants with chronic lung disease. We have previously shown that these newborn infants increase their oxygen consumption (V'O 2 ) at the time of being weaned from mechanical ventilation [1]. This increase is secondary to a high oxygen cost of breathing (OCB) probably related to increased work of breathing, similar to that shown in adult patients [2]. Inspiratory pressure support, used during the weaning process in adult intensive care, may be useful in reducing the work of breathing [2]. Recent data have shown that patient triggered ventilation (PTV) decreases the work of breathing in premature neonates [3], and that PTV can be used as a weaning ventilatory mode [4][5][6][7]. We hypothesized that the increase in V'O 2 observed at the time of weaning in some newborn infants could be reduced by using PTV. We designed a study to assess V'O 2 during PTV as compared to synchronous intermittent mandatory ventilation (SIMV) and continuous positive airway pressure (CPAP) in newborn infants, before being weaned from mechanical ventilation. MethodsThe population was selected to include patients with normal and high OCB. Thus, in this prospective study, we included 16 infants requiring assisted ventilation for either acute respiratory distress (eight infants) or chronic lung disease (eight infants), after informed consent was obtained from the parents. The clinical characteristics, which covered a wide range, were at the time of measurement: gestational age; 33.9±1.0 (range, 28±41) weeks; postnatal age; 18±4 (2-65) days; postconceptional age; 36. 5±1.3 (31.3-48.3) weeks; and weight; 2.3±0.2 (1.4-3.5) kg.

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Section: Resultsmentioning

confidence: 94%

mentioning

confidence: 78%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

See 3 more Smart Citations

Oxygen cost of breathing and weaning process in newborn infants

Rozé¹,

Liet²,

Gournay³

et al. 1997

Eur Respir J

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Higher SaO2 in chronic neonatal lung disease: Does it improve sleep?

et al. 1998

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Sleep fragmentation, decreased rapid eye movement (REM) sleep time, and REM sleep hypoxemia have been reported in infants with chronic neonatal lung disease (CNLD) in early infancy despite an awake hemoglobin oxygen saturation (SaO2) >93%. Interestingly, higher inspired O2 concentrations have been demonstrated to reduce REM sleep fragmentation in CNLD patients in middle infancy. However, the effect of increased SaO2 on sleep architecture in infants with CNLD near the time of discharge from neonatal intensive care has not been reported. We performed paired overnight polysomnography in a sleep laboratory on 16 infants with CNLD (4 weeks median corrected age) in air or their usual inspired oxygen (SaO2 >93%) and again when receiving 0.25 L/min higher than baseline inspired oxygen via nasal catheters (SaO2 >97%). A control group of seven healthy preterm infants was similarly studied. For CNLD infants on supplemented O2, sleep duration decreased by 15% (422 ± 66 min vs. 359 ± 89 min; P < 0.005), and sleep efficiency decreased by 7% (73.2 ± 10.6% vs. 66.4 ± 14.0%; P < 0.005) but percentage of time in REM sleep (REM%) (31.5 ± 8.9% vs. 29.8 ± 8.6%; P = 0.560), REM epoch duration (12.4 ± 2.8 min vs. 13.4 ± 4.3 min; P = 0.420), and REM arousal index (18.6 ± 6.5 vs. 18.8 ± 7.2; P = 0.990) were not significantly affected. Conversely, higher O2 did not alter sleep architecture in the control group. The mean non‐REM (NREM) respiratory rate decreased (CNLD: P = 0.003; controls: P = 0.02), NREM SaO2 increased (P < 0.05), although the mean transcutaneous CO2 was unaltered in both CNLD and control groups. This study confirmed low REM% in CNLD infants in early infancy and demonstrated that a higher SaO2 adversely affected sleep time but did not influence REM sleep duration or arousal frequency. A target SaO2 >93% is, therefore, as efficacious as an SaO2 >97% in optimizing sleep architecture in CNLD infants. Pediatr Pulmonol. 1998; 26:235–240. © 1998 Wiley‐Liss, Inc.

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Sleep, respiratory rate, and growth hormone in chronic neonatal lung disease

et al. 1998

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This study assessed whether respiratory rates (RRs) correlate with urinary growth hormone (U‐GH) excretion and sleep architecture in infants with chronic neonatal lung disease (CNLD) in early (1 month), middle (6 months), and late (10 months) infancy. Twenty‐three preterm infants (CNLD = 16, controls = 7) were studied on 51 occasions. CNLD infants were stratified according to mean non‐REM sleep respiratory rate (NREM RR) in early infancy into “High RR CNLD” infants (mean NREM RR >2 SD higher than controls) and “Normal RR CNLD” infants (mean NREM RR within 2 SD of controls' mean). “High RR CNLD” infants (RR >45) had a lower mean birthweight (P = 0.015), current weight (P = 0.042), current length (P = 0.02), and growth velocity in early infancy (grams/week gained: P = 0.042) than “Normal RR CNLD” and control infants. Mean (95% CI) U‐GH excretion (ng U‐GH/g urinary creatinine) was higher in “High RR CNLD” infants in air or their usual O2 (1,932 [459, 3,406]) than “Normal RR CNLD” (394 [147, 642]) and controls (320 [147, 492]) (P = 0.024). With resolution of tachypnea by mid‐infancy, hemoglobin oxygen saturation (SaO2) >93%, mean growth parameters and U‐GH excretion for the “High RR CNLD” group were not significantly different from “Normal RR CNLD” and control groups. CNLD infants demonstrated increased sleep efficiency (P = 0.016), whereas controls had similar sleep efficiency between early and middle infancy (P = 0.452). Mean percent time in REM sleep (REM%) and slow wave sleep (SWS%) were not significantly different between early and middle infancy and did not vary in relation to respiratory rate. We conclude that tachypneic infants with CNLD have slower growth and elevated U‐GH excretion in early infancy. With resolution of tachypnea, growth improved, U‐GH excretion decreased, and sleep consolidation occurred. An elevated U‐GH in tachypneic CNLD infants may reflect stress, compromised nutrition (GH resistance), or a feedback loop involving a direct effect of GH on lung growth and repair. Pediatr Pulmonol. 1998; 26:241–249. © 1998 Wiley‐Liss, Inc.

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Oxygen cost of breathing in newborn infants with long-term ventilatory support

Cited by 19 publications

References 11 publications

Oxygen cost of breathing and weaning process in newborn infants

Oxygen cost of breathing and weaning process in newborn infants

Higher SaO2 in chronic neonatal lung disease: Does it improve sleep?

Sleep, respiratory rate, and growth hormone in chronic neonatal lung disease

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