Sustained inflation: The lung recruitment maneuvers for neonates

Yang

Chen³

et al. 2021

Preprint

OBJECTIVE: Sustained pharyngeal inflation (SPI) with pharyngeal oxygen and nose-close (PhO2-NC) can create positive peak inflation pressure (PIP) inside the pharyngolaryngeal space (PLS). This study measured and compared effects of four different SPI durations in the PLS. METHOD: In this prospective observational study, 20 consecutive infants aged less than 3 years, scheduled for elective flexible-bronchoscopy were enrolled. SPI was performed twice in four different durations (0, 1, 3 and 5 seconds) sequentially in each infant. PIP was measured for each SPI in the pharynx, and simultaneously took images at two locations of oropharynx and supra-larynx. Infants’ demographic details and PIP levels, lumen expansion scores and images of PLS were measured and analyzed. RESULTS: Twenty infants with 40 measurements were collected. The mean (SD) age and weight were 11.6 (9.1) months and 6.8 (2.4) kg, respectively. The measured mean (SD) pharyngeal PIPs were 4.1 (3.3), 21.9 (7.0), 42.2 (12.3) and 65.5 (18.5) cm H2O at SPI duration of 0, 1, 3 and 5 seconds, respectively; which showed significant positive association (p<0.001). At assigned locations, the corresponding PLS images also show significant increase in lumen expansion scores and number of detected lesions with increase in SPI duration (p<0.001). The mean (SD) study time was 5.7 (1.2) minutes. No study related complication was noted. CONCLUSIONS: SPI with PhO2-NC up to 5 seconds is a simple, safe and feasible clinical ventilation modality. It may provide enough PIP to expand the PLS and facilitate flexible-bronchoscopy performance in infants.

Section: Discussionmentioning

confidence: 99%

“…Traditionally, this sustained inflation is accomplished with a gas flow delivered via different devices of Ambu-facemask, bi-nasal prongs, laryngeal mask airway (LMA), or endotracheal tube (ETT). [1][2][3][4][5][6][7][8] The sustained inflation has gradually become a widespread clinical practice.…”

Section: Introductionmentioning

confidence: 99%

Sustained pharyngeal inflation on upper airway effects in infants---flexible bronchoscopy measurement

Yang

Chen³

et al. 2021

Preprint

“…This indeed may affect the levels of measured pressure. A more prolonger duration of SPI, up to 15 seconds or more had been reported, 3,8 but it was not included in this primitive study because worry its adverse effects of high created PIP. In clinical practice, the real effort of SPI may individualize but that is controlled by the operators.…”

Section: Discussionmentioning

confidence: 99%

“…Traditionally, this kind of sustained inflation (SI) is accomplished with a gas flow that delivers via different devices of Ambu-facemask, bi-nasal prongs, laryngeal mask airway (LMA), or endotracheal tube (ETT). [1][2][3][4][5][6][7][8] This SI has gradually become a widespread clinical practice. Theoretically, in a relative close space like the PLS, the levels of created PIP may positively correlate to the durations of SPI.…”

mentioning

confidence: 99%

Sustained pharyngeal inflation with oxygen tube effects on upper airway pressure and lumen changes in infants---flexible bronchoscopy measurement

Chen²,

Lin

et al. 2020

Preprint

Sustained pharyngeal inflation (SPI) with pharyngeal oxygen and nose-close (PhO2-NC) can create positive inflation pressure (PIP) inside the pharyngolaryngeal space (PLS). This study measured and compared effects of different SPI durations in the PLS. Method: A one-year prospective study, 20 consequent infants whose age less than 3-year-old and scheduled for elective FB were enrolled. SPI performed in four different durations (0.0, 1.0, 3.0 and 5.0 seconds) consequently. Each infant did two cycles of SPI. Measured the PIP of each SPI in the pharynx, and simultaneously took images at three locations of oropharynx, supra-larynx and larynx. Data of infant's demographics, PIP levels, space expansion scores and images were collected and analyzed. Results: Total 20 studied infants, the mean (SD) age was 11.6 (9.1) month-old, the mean (SD) body weight was 6. 8 (2.4) kg and the mean (SD) study time was 3.8 (1.1) minutes. The measured mean (SD) pharyngeal PIPs were 4.1 (3.3), 21.9 (7.0), 42.2 (12.3) and 65.5 (18.5) cmH2O at SPI duration of 0.0, 1.0, 3.0 and 5.0 seconds, respectively. Which showed positively and significantly (p<0.001) correlations. At these assigned locations, the corresponding PLS images also show significant lumen expansion correlated with the PIP. Especially, when there existed pathologic or occult lesions. No any study related complication was noted. Conclusions: SPI with PhO2-NC up to 5 seconds is a simple, safe and feasible clinical ventilation modality. Which could provide enough PIP to expand the PLS and benefit FB performance in infants. Title pagesSustained pharyngeal inflation with oxygen tube effects on upper airway pressure and lumen changes in infants-flexible bronchoscopy measurement

“…Sustained pharyngeal inflation (SPI) is an assisted positive pressure ventilation (PPV) maneuver that delivers prolonged inspiration time where positive peak inflation pressure (PIP) is created inside the pharyngolaryngeal space (PLS). In children with patent airways, a prolonged pressurized airflow provides sufficient time and adequate pressure gradient needed for expanding airway lumens and alveoli, promoting gas‐exchange across air–fluid interface 1–4 . Traditionally, this clinical sustained inflation is accomplished by gas flow delivered via artificial devices such as Ambu‐facemask, bi‐nasal prongs, T‐piece resuscitator, laryngeal mask airway (LMA), or endotracheal tube (ET) 4 .…”

Section: Introductionmentioning

confidence: 99%

Sustained pharyngeal inflation on upper airway effects in children—Flexible bronchoscopy measurement

Chen

Lin

et al. 2021

Pediatric Pulmonology

Objective Sustained pharyngeal inflation (SPI) with pharyngeal oxygen and nose‐closure (PhO2‐NC) can create positive peak inflation pressure (PIP) inside the pharyngolaryngeal space (PLS). This study measured and compared the effects of four different SPI durations in the PLS. Methods A prospective study, 20 consecutive children aged between 6 months and 3 years old, scheduled for elective flexible bronchoscopy (FB) suspected positive PLS findings were enrolled. SPI was performed twice in four different durations (0, 1, 3, and 5 s) sequentially in each infant. PIP was measured for each SPI in the pharynx, while simultaneously record images at two locations of the oropharynx and supra‐larynx. Patient demographic details, PIP levels, lumen expansion scores, and images of PLS were measured and analyzed. Results Twenty patients with 40 measurements were collected. The mean (SD) age and weight were 11.6 (9.1) months and 6.8 (2.4) kg, respectively. The measured mean (SD) pharyngeal PIPs were 4.1 (3.3), 21.9 (7.0), 42.2 (12.3), and 65.5 (18.5) cmH2O at SPI duration of 0, 1, 3, and 5 s, respectively, indicating significant (p<.001) positive correlation. At assigned locations, corresponding PLS images also displayed a significant increase in lumen expansion scores and a number of detected lesions with an increase in SPI duration (p < .004). The mean (SD) procedural time was 5.7 (1.2) min. No study‐related complication was noted. Conclusions FB utilizing PhO2‐NC as SPI of 1–3 s is a simple, less invasive, and valuable ventilation modality. It provides an adequate PIP level to expand the PLS and improve FB performance in children.