Relationship between respiratory impedance and positive end-expiratory pressure in mechanically ventilated neonates

Dellacà, Raffaele L.; Veneroni, Chiara; Vendettuoli, Valentina; Zannin, Emanuela; Matassa, Piero Giuseppe; Pedotti, A.; Colnaghi, Mariarosa; Mosca, Fabio

doi:10.1007/s00134-012-2795-6

Cited by 23 publications

(28 citation statements)

References 23 publications

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“…FOT is very sensitive to its changes with PEEP, making this method a promising technique for the noninvasive bedside titration of mechanical ventilation in preterm newborns [61].…”

Section: Respiratory and Mechanical Ventilationmentioning

confidence: 99%

Year in review in Intensive Care Medicine 2013: III. Sepsis, infections, respiratory diseases, pediatrics

et al. 2014

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“…FOT is very sensitive to its changes with PEEP, making this method a promising technique for the noninvasive bedside titration of mechanical ventilation in preterm newborns [61].…”

Section: Respiratory and Mechanical Ventilationmentioning

confidence: 99%

Year in review in Intensive Care Medicine 2013: III. Sepsis, infections, respiratory diseases, pediatrics

et al. 2014

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“…The difficulty in assessing lung mechanics in small preterm newborns is a major factor preventing a better understanding of the effect of prone positioning. Recently, the forced oscillation technique (FOT), a non‐invasive method for the assessment of respiratory mechanical properties, has been successfully applied to the study of respiratory mechanics in preterm infants during mechanical ventilation . Briefly, FOT determines the mechanical properties of the respiratory system by its response to a small high‐frequency (≥5 Hz) oscillatory pressure super‐imposed on the standard breathing signal, allowing an accurate assessment of lung mechanics without interfering with the spontaneous breathing activity of the patient.…”

Section: Introductionmentioning

confidence: 99%

Positional effects on lung mechanics of ventilated preterm infants with acute and chronic lung disease

Vendettuoli

Veneroni

Zannin

et al. 2014

Pediatric Pulmonology

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“…For conventional ventilation, a relationship between end-expiratory lung volume (V L ), recruitment, and tidal breath mechanics has been demonstrated repeatedly (9,10). During HFOV, the same theoretical considerations apply (3), but the best means of assessing the mechanics of the oscillated lung remains unclear.A promising approach to noninvasive bedside assessment of lung mechanics in ventilated newborns is the forced oscillation technique (FOT) (11)(12)(13)(14). FOT measures the mechanical impedance of the respiratory system (Z RS ) by evaluating its response to pressure oscillations (15).…”

mentioning

confidence: 99%

“…A promising approach to noninvasive bedside assessment of lung mechanics in ventilated newborns is the forced oscillation technique (FOT) (11)(12)(13)(14). FOT measures the mechanical impedance of the respiratory system (Z RS ) by evaluating its response to pressure oscillations (15).…”

mentioning

confidence: 99%

“…Unfortunately, clinical application of LFOT for continuous bedside monitoring is limited by its high sensitivity to leaks and, importantly, by the interference of spontaneous breathing on the low-frequency components of the forcing signal. Recently, single-frequency FOT has been applied during conventional mechanical ventilation both in animal models (17,20,22,23) and in ventilated preterm newborns (11). In particular, X RS at 5 Hz (X RS ) identified the lowest positive endexpiratory pressure level able to keep the lung fully recruited (22,23), minimizing lung injury (23).…”

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confidence: 99%

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Optimal mean airway pressure during high-frequency oscillatory ventilation determined by measurement of respiratory system reactance

et al. 2013

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Background:The aims of the present study were (i) to characterize the relationship between mean airway pressure (P AW ) and reactance measured at 5 Hz (reactance of the respiratory system (X RS ) , forced oscillation technique) and (ii) to compare optimal P AW (P opt ) defined by X RS , oxygenation, lung volume (V L ), and tidal volume (V T ) in preterm lambs receiving high-frequency oscillatory ventilation (HFOV). Methods: Nine 132-d gestation lambs were commenced on HFOV at P AW of 14 cmH 2 O (P start ). P AW was increased stepwise to a maximum pressure (P max ) and subsequently sequentially decreased to the closing pressure (P cl , oxygenation deteriorated) or a minimum of 6 cmH 2 O, using an oxygenation-based recruitment maneuver. X RS , regional V L (electrical impedance tomography), and V T were measured immediately after (t 0min ) and 2 min after (t 2min ) each P AW decrement. P opt defined by oxygenation, X RS , V L , and V T were determined. results: The P AW -X RS and P AW -V T relationships were dome shaped with a maximum at P cl +6 cmH 2 O, the same point as P opt defined by V L . Below P cl +6 cmH 2 O, X RS became unstable between t 0min and t 2min and was associated with derecruitment in the dependent lung. P opt , as defined by oxygenation, was lower than the P opt defined by X RS , V L , or V T . conclusion: X RS has the potential as a bedside tool for optimizing P AW during HFOV. h igh-frequency oscillatory ventilation (HFOV) is used to treat severe neonatal lung disease and has the potential to reduce ventilator-induced lung injury when applied optimally (1,2). HFOV optimally applied aims to recruit the lung and subsequently reduce mean airway pressure (P AW ) to an optimal pressure (P opt ) that achieves optimal lung recruitment at the lowest distending pressure (open lung strategy) (3,4). However, identification and maintenance of P opt remains challenging, particularly in the newly born, whose lungs are in a highly dynamic state because of fluid reabsorption and establishment of functional residual capacity (5). The lack of appropriate tools for the bedside assessment and continuous monitoring of lung function in infants makes targeting of P opt even more difficult.Oxygenation, evaluated by monitoring oxygen saturation (Sp O2 ), is most commonly used for targeting P opt during HFOV in clinical practice (6). However, Sp O2 is an imperfect guide for P AW titration as it is relatively uniform over a wide range of airway pressures and volumes (7). Beginning with the observations of Suter et al. (8), the notion that lung mechanics can guide pressure settings during mechanical ventilation has been examined carefully. For conventional ventilation, a relationship between end-expiratory lung volume (V L ), recruitment, and tidal breath mechanics has been demonstrated repeatedly (9,10). During HFOV, the same theoretical considerations apply (3), but the best means of assessing the mechanics of the oscillated lung remains unclear.A promising approach to noninvasive bedside assessment of lung mechanics ...

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Relationship between respiratory impedance and positive end-expiratory pressure in mechanically ventilated neonates

Abstract: Rrs and Xrs measurement in preterm newborns is feasible, and data are representative of the lung mechanics and very sensitive to its changes with PEEP, making FOT a promising technique for the non-invasive bedside titration of mechanical ventilation in preterm newborns.

Cited by 23 publications

References 23 publications

Year in review in Intensive Care Medicine 2013: III. Sepsis, infections, respiratory diseases, pediatrics

Year in review in Intensive Care Medicine 2013: III. Sepsis, infections, respiratory diseases, pediatrics

Positional effects on lung mechanics of ventilated preterm infants with acute and chronic lung disease

Optimal mean airway pressure during high-frequency oscillatory ventilation determined by measurement of respiratory system reactance

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