The effect of 100% oxygen on tidal breathing parameters in preschool children

Foong, Rachel E.; Harper, Alana; Hall, Graham L.; Ramsey, Kathryn

doi:10.1183/13993003.01959-2016

Cited by 5 publications

(3 citation statements)

References 9 publications

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“…Taking all into account, it seems unlikely that the different software versions used in our study with their inherent algorithms to process signals to MBW parameters are a major determinant contributing to differences between N 2 -and SF 6 -LCI observed. Some studies detected a decrease in VT during inhalation of 100% O 2 in infants, preschool children, and even young adults of up to 29 years [34,[42][43][44]. However, these studies observed a minimal effect on breathing pattern after early infancy, which is in line with our study in older infants and children demonstrating no difference in VT and RR between N 2 -and SF 6 -MBW (Table 2).…”

Section: Discussionsupporting

confidence: 90%

Comparison of lung clearance index determined by washout of N2 and SF6 in infants and preschool children with cystic fibrosis

Stahl

Joachim

Wielpütz

et al. 2019

Journal of Cystic Fibrosis

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Background: Multiple-breath washout (MBW) has been shown to detect early impairment of lung function in children with cystic fibrosis (CF). Nitrogen (N 2 ) or sulfur hexafluoride (SF 6 ) can be used as tracer gas for MBW. Recent data indicated higher lung clearance index (LCI) values measured with N 2 -MBW than concurrent SF 6 -MBW in older children and adults, however, a comparison in infants and younger children, as well as to other outcome measures of CF lung disease is pending. Methods: N 2 -and SF 6 -MBW were performed consecutively in 31 sedated infants and preschool children with CF (mean age, 2.3 ± 0.8 years) and 20 controls (mean age, 2.3 ± 1.1 years) using the Exhalyzer D system. Children with CF also underwent chest magnetic resonance imaging (MRI). Results: Mean difference (95% CI) in LCI between N 2 -and SF 6 -MBW was 1.1 ± 0.4 (0.9 to 1.3) in controls and 2.1 ± 1.9 (1.4 to 2.8) in CF. Agreement between N 2 -and SF 6 -LCI was poor in children with CF. N 2 -LCI and SF 6 -LCI correlated with MRI, however N 2 -LCI showed a higher concordance with MRI than SF 6 -LCI. The absolute difference between N 2 -and SF 6 -LCI values increased with the severity of CF lung disease as determined by MRI scores. Conclusion: N 2 -LCI values were higher than SF 6 -LCI values in infants and preschool children with CF and controls. Better concordance of N 2 -LCI than SF 6 -LCI with chest MRI scores point towards of a higher sensitivity of N 2 -LCI to detect early lung disease in children with CF.

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Section: Discussionsupporting

confidence: 90%

Comparison of lung clearance index determined by washout of N2 and SF6 in infants and preschool children with cystic fibrosis

Stahl

Joachim

Wielpütz

et al. 2019

Journal of Cystic Fibrosis

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“…The lower VT during nitrogen washout seems to be a consequence of hyperoxic conditions during washout phase ("peripheral chemodenervation") [8,9]. Although the VT recovers or even exceeds the normoxic values after approximately 60 s, in the end effect, average VT is lower compared to normoxaemia.…”

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confidence: 98%

Nitrogen multiple breath washout test for infants with cystic fibrosis

2018

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Multiple breath washout test (MBW) with lung clearance index (LCI) as a main outcome parameter has proven to be a valuable research tool in patients with cystic fibrosis (CF) [1, 2]. Moreover, there is growing evidence of its relevance in routine clinical practice [3]. Nevertheless, some technical limitations remain that hamper its widespread use. While most of the MBW data in infants have been acquired via sulfur hexafluoride washout (SF 6-MBW), the nitrogen variant (N 2-MBW) is recommended by the European Cystic Fibrosis Society Clinical Trial Network (ECFS-CTN) for older children. However, this methodological discrepancy may limit long-term follow-up of cystic fibrosis patients because N 2and SF 6-MBW cannot be used interchangeably. In infants, the N 2-MBW has not been fully investigated to date. We report our data regarding safety, feasibility and repeatability of N 2-MBW in cystic fibrosis infants. Between January 2015 and January 2017, we performed lung function testing in 35 infants aged 6.7-25.2 months (median 14.7) with classical form of cystic fibrosis. Testing was performed in patients without any signs of acute respiratory infection for at least 14 days. Quiet sleep was induced by administering chloral hydrate 80-100 mg•kg −1 per rectum. The patients were placed in a supine position with their head and neck in a neutral position, and a Rendell-Baker face mask Nr. 1 or 2 (selected to keep the instrument dead space under 2 mL•kg −1) was tightly sealed around the mouth and nose. At first, N 2-MBW was performed using the Exhalyzer D device (Ecomedics, Duernten, Switzerland) with the Spiroware 3.2.0 software, following all the relevant recommendations [4, 5]. When finished, at least 120 s of medical air breathing followed (normalisation of breath pattern, nitrogen back wash-in). Afterwards, SF 6-MBW was performed using the same device and software within a subgroup of 10 patients, who were tested after March 2016 (SF 6-MBW became available in our centre); their anthropometric parameters and age were not significantly different from those of the whole study group. Both measurements were performed in fixed order within the same sedation period and without changing the body and face mask position. The technical acceptability of trials was assessed by a physician with ECFS-CTN certification in this method and adhered to the standard operating procedure for N 2-MBW [5] modified for infants and SF 6-MBW. Both tests were repeated at least three times to obtain a coefficient of variation (CV) lower than 10%. Pulse rate and haemoglobin oxygen saturation were continuously monitored during MBW measurements and until full consciousness was regained. A pair-wise t-test was used to compare results from SF 6and N 2-MBW in individual patients with both measurements available (n=8). Patient's characteristics between the N 2-MBW and SF 6-MBW group were compared by the t-test. The reliability of N 2-MBW was assessed using estimates of intraclass correlation (ICC). Coefficient of repeatability was calculated as follows: 1.96×...

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The effects of 100% oxygen on breathing pattern are not limited to young children

et al. 2018

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Breathing 100% oxygen has been reported to decrease tidal volume (VT) in infants [1] and recent evidence published in the European Respiratory Journal suggest that transient less pronounced effects are also seen in preschool children [2]. It is unclear whether there is an age dependency beyond infancy in the response to 100% oxygen or whether it is limited to young children. Here we investigate the effects of 100% oxygen on breathing pattern across a spectrum of ages to identify the change in VT that occurs when subjects breathe 100% oxygen during a multiple breath nitrogen washout (MBNW) test.MBNW testing was performed [3] with the Exhalyzer® D using Spiroware 3.1 software (EcoMedics AG, Dürnten, Switzerland). Preschool children were tested using a mask whereas older children and adults used a mouth piece. All trials were re-run through Spiroware 3.2.0 to obtain breath-by-breath output of VT, respiratory rate (RR) and minute ventilation (V′E) for all pre-washout and washout breaths. The average VT , RR and V′E of the last 5 breaths of the pre-phase was compared to each washout breath to calculate a relative change in each parameter. We also compared the final 5 breaths of the pre-phase to the average all of breaths collected during the washout phase. A non-linear regression analysis was used to model the breath-by-breath changes. In total data collected from 112 preschool children (50 healthy and 62 with cystic fibrosis (CF)) [4], 18 school age children (all with CF) [5] and 10 adults (all healthy) were include in the analysis. Combined, the subjects ranged from 2.5 years to 29 years of age (median 4.8 years, interquartile range (3.7-17.5)) and 63% of participants were male.Exposure to 100% oxygen resulted in an initial decrease in VT, RR and V′E in all three age groups (figure 1), followed by a return to pre-phase levels. This effect was observed in both healthy subjects and those with CF. The average VT of the entire washout was not significantly different when compared to the pre-phase in all groups (0.8% decrease in healthy preschool children, 3.2% and 3.9% decrease in preschool and school age children with CF, respectively, and a 1.6% decrease in healthy adults).Our findings are thus consistent with two recent studies that compared the average pre-phase VT to the average VT during the washout phase in preschool [2] and school age children [6]. FOONG et al.[2] observed a 13 mL (4.8%) decrease in VT whereas JOST et al.[6] observed a 9.7 mL (3.5%) decrease in VT. In infants, breath-by-breath analysis demonstrated temporary hypoventilation driven by a decrease in VT after 2-4 breaths, which remained low for 10-25 breaths before returning to baseline [1]. Therefore, changes in tidal breathing in response to exposure to 100% oxygen observed in infants are not unique to this age group. Rather, they are a phenomena exhibited by subjects of all ages with the magnitude of the effect being small after early infancy. This is important for longitudinal studies with MBNW measurements, as breathing 100% oxygen is unlikely...

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The effect of 100% oxygen on tidal breathing parameters in preschool children

Cited by 5 publications

References 9 publications

Comparison of lung clearance index determined by washout of N2 and SF6 in infants and preschool children with cystic fibrosis

Comparison of lung clearance index determined by washout of N2 and SF6 in infants and preschool children with cystic fibrosis

Nitrogen multiple breath washout test for infants with cystic fibrosis

The effects of 100% oxygen on breathing pattern are not limited to young children

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