Total Respiratory Compliance During Anaesthesia in Infants and Young Children

Fletcher, Margaret; Stocks, Janet; Ridley, S.; Braude, N.; Yates, A.; Hatch, D. J.

doi:10.1093/bja/63.3.266

Cited by 7 publications

(5 citation statements)

References 16 publications

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“…Applying an automatic computation with the single breath occlusion technique available in modern ventilators, it has been reported an average compliance of respiratory system of 22.8 ± 12 ml/cmH 2 O [ 37 ]. In a group of younger patients with a mean age from 1 to 25 months, the compliance of respiratory system was significantly lower compared with published data with an average value of 4 ml/cmH 2 O [ 36 ].…”

Section: Discussionmentioning

confidence: 67%

“…In order to correctly compare the data of respiratory mechanics reported by the different studies, it is essential to consider the patients’ age, the technique applied (static or dynamic, inspiratory or expiratory pressure volume curve), the presence of sedation or anesthesia, the size of tidal volume and the level of applied PEEP [ 32 , 36 ]. In our study evaluating the respiratory mechanics during inspiration in static conditions, the control group (i.e., healthy children) had an average compliance of the respiratory system of 17.4 ± 4.3 (ranging between 14.7 and 20.6 ml/cmH 2 O).…”

Section: Discussionmentioning

confidence: 99%

“…However, compliance did not change with the amount of tidal volume and/or the level of PEEP, suggesting a mixed effect of possible simultaneous lung recruitment and over-distension. Fletcher et al [ 36 ] found a significant increase in the compliance of respiratory system when tidal volume was increased from 3.3 to 9.3 ml/kg only in anesthetized children. In children with non-cardiogenic pulmonary edema, the increase in PEEP from 0 to 18 cmH 2 O improved the compliance of respiratory system in only 60 % of the patients [ 18 ].…”

Section: Discussionmentioning

confidence: 99%

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Respiratory mechanics and lung stress/strain in children with acute respiratory distress syndrome

Chiumello

Chidini

Calderini

et al. 2016

Ann. Intensive Care

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Background In sedated and paralyzed children with acute respiratory failure, the compliance of respiratory system and functional residual capacity were significantly reduced compared with healthy subjects. However, no major studies in children with ARDS have investigated the role of different levels of PEEP and tidal volume on the partitioned respiratory mechanic (lung and chest wall), stress (transpulmonary pressure) and strain (inflated volume above the functional residual capacity).MethodsThe end-expiratory lung volume was measured using a simplified closed circuit helium dilution method. During an inspiratory and expiratory pause, the airway and esophageal pressure were measured. Transpulmonary pressure was computed as the difference between airway and esophageal pressure.ResultsTen intubated sedated paralyzed healthy children and ten children with ARDS underwent a PEEP trial (4 and 12 cmH2O) with a tidal volume of 8, 10 and 12 ml/kgIBW. The two groups were comparable for age and BMI (2.5 [1.0–5.5] vs 3.0 [1.7–7.2] years and 15.1 ± 2.4 vs 15.3 ± 3.0 kg/m2). The functional residual capacity in ARDS patients was significantly lower as compared to the control group (10.4 [9.1–14.3] vs 16.6 [11.7–24.6] ml/kg, p = 0.04). The ARDS patients had a significantly lower respiratory system and lung compliance as compared to control subjects (9.9 ± 5.0 vs 17.8 ± 6.5, 9.3 ± 4.9 vs 16.9 ± 4.1 at 4 cmH2O of PEEP and 11.7 ± 5.8 vs 23.7 ± 6.8, 10.0 ± 4.9 vs 23.4 ± 7.5 at 12 cmH2O of PEEP). The compliance of the chest wall was similar in both groups (76.7 ± 30.2 vs 94.4 ± 76.4 and 92.6 ± 65.3 vs 90.0 ± 61.7 at 4 and 12 cmH2O of PEEP). The lung stress and strain were significantly higher in ARDS patients as compared to control subjects and were poorly related to airway pressure and tidal volume normalized for body weight.ConclusionsAirway pressures and tidal volume normalized to body weight are poor surrogates for lung stress and strain in mild pediatric ARDS.Trial registration: Clinialtrials.gov NCT02036801. Registered 13 January 2014Electronic supplementary materialThe online version of this article (doi:10.1186/s13613-016-0113-0) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 67%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Respiratory mechanics and lung stress/strain in children with acute respiratory distress syndrome

Chiumello

Chidini

Calderini

et al. 2016

Ann. Intensive Care

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“…These observations in healthy, sleeping infants are in marked contrast to a recent study of anesthetized infants of similar age (4), in whom HBIR activity could not be elicited during EIO, whereas some weak activity (equivalent to a mean IR of 1.2) was found during EEO. These discrepancies may be related to the reduction in both tidal volume and FRC induced by inhalation of volatile anesthetics such as halothane (13) such that the volume threshold for stimulation of the phasic PSRs may not have been reached at end-tidal inspiration in these infants. They may also reflect some interdependence between chemo-and mechanoreflexes because most of the anesthetized infants showed some hypoventilation, with elevated CO 2 levels, which would be expected to inhibit HBIR activity (18,19,24).…”

Section: Discussionmentioning

confidence: 99%

Influence of volume dependency and timing of airway occlusions on the Hering-Breuer reflex in infants

Rabbette

Stocks

1998

Journal of Applied Physiology

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Both end-inspiratory (EIO) and end-expiratory (EEO) airway occlusions are used to calculate the strength of the Hering-Breuer inflation reflex (HBIR) in infants. However, the influence of the timing of such occlusions is unknown, as is the extent to which changes in volume within and above the tidal range affect this reflex. The purpose of this study was to compare both techniques and to evaluate the volume dependency of the HBIR in healthy, sleeping infants up to 1 yr of age. The strength of the HBIR was expressed as the ratio of expiratory or inspiratory time during EIO or EEO, respectively, to that recorded during spontaneous breathing, i.e., as the "inhibitory ratio" (IR). Paired measurements of the EIO and EEO in 26 naturally sleeping newborn and 15 lightly sedated infants at approximately 1 yr showed no statistically significant differences in the IR according to technique: mean (95% CI) of the difference (EIO - EEO) being -0.02 (-0.17, 0.13) during the first week of life and 0.04 (-0.14, 0.22) at 1 yr. During tidal breathing, a volume threshold of approximately 4 ml/kg was required to evoke the HBIR. Marked volume and age dependency were observed. In newborn infants, occlusions at approximately 10 ml/kg during sighs always resulted in an IR > 4, whereas a similar response was only evoked at 25 ml/kg in older infants. Age-related changes in the volume threshold may reflect maturational changes in the control of breathing and respiratory mechanics throughout the first year of life.

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“…MEASUREMENT OF HBIR IN ANESTHETIZED INFANTS reasons for these discrepancies are probably related to both specific effects of anesthetic agents on the control of breathing and to the reduction in both lung volume (9) and VT (4, 12) induced by inhalation of volatile anesthetics such as halothane (13). They might also reflect some interdependence between chemo-and mechanoreflexes because any degree of hypoventilation, such as commonly occurs in anesthetized subjects during spontaneous breathing (2), would be expected to inhibit HBIR activity (19,20,28).…”

mentioning

confidence: 99%

The Hering-Breuer reflex in anesthetized infants: end-inspiratory vs. end-expiratory occlusion technique

Brown

Stocks

Aun

et al. 1998

Journal of Applied Physiology

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Both end-inspiratory (EIO) and end-expiratory (EEO) occlusions have been used to measure the strength of the Hering-Breuer inflation reflex (HBIR) in infants. The purpose of this study was to compare both techniques in anesthetized infants. In each infant, HBIR activity was calculated as the relative prolongation of expiratory and inspiratory time during EIO and EEO, respectively. Respiratory drive was assessed from the change in airway pressure during inspiratory effort against the occlusion, both at a fixed time interval of 100 ms (P0.1) and a fixed proportion (10%) of the occluded inspiratory time (P10%). Twenty-two infants [age 14.3 +/- 6. 4 (SD) mo] were studied. No HBIR activity was present during EIO [-11.8 +/- 15.9 (SD) %]. By contrast, there was significant, albeit weak, reflex activity during EEO [HBIR: 27.2 +/- 17.4%]. A strong HBIR (up to 310%) was elicited in six of seven infants in whom EIO was repeated after lung inflation. P0.1 was similar during both types of occlusions, whereas mean +/- SD P10% was lower during EEO than during EIO: 0.198 +/- 0.09 vs. 0.367 +/- 0.15 kPa, respectively (P < 0.01). These data suggest a difference in the central integration of stretch receptor activity in infants during anesthesia compared with during sleep.

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Total Respiratory Compliance During Anaesthesia in Infants and Young Children

Cited by 7 publications

References 16 publications

Respiratory mechanics and lung stress/strain in children with acute respiratory distress syndrome

Respiratory mechanics and lung stress/strain in children with acute respiratory distress syndrome

Influence of volume dependency and timing of airway occlusions on the Hering-Breuer reflex in infants

The Hering-Breuer reflex in anesthetized infants: end-inspiratory vs. end-expiratory occlusion technique

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