Abstract
Objectives
We compared ventilation inhomogeneity assessed by electrical impedance tomography (EIT) and multiple breath washout (MBW) in preterm and term-born infants. We hypothesised that EIT measurements in spontaneously breathing infants are repeatable and that differences in regional ventilation distribution measured by EIT can distinguish between preterm and term-born infants.
Design
Cross-sectional group comparison study.
Setting
Lung function laboratory at a University Children’s Hospital.
Participants
Seventeen healthy term-born and 15 preterm infants at a matched postmenstrual age of 44 weeks.
Measurements and results
We concurrently measured ventilation inhomogeneity by EIT, ventilation inhomogeneity (LCI) and functional residual capacity (FRC) by MBW and tidal breathing variables during unsedated quiet sleep. EIT measurements were highly repeatable (coefficient of variation 3.6%). Preterm infants showed significantly more ventilation of the independent parts of the lungs compared to healthy term-born infants assessed by EIT (mean difference 5.0, 95 CI 1.3–8%). Whereas the two groups showed no differences in lung volumes or ventilation inhomogeneities assessed by MBW, EIT discriminated better between term and preterm infants. (FRC/kg: mean difference 1.1 mL, 95% CI −1.4–3.8 mL; LCI: mean difference 0.03, 95% CI −0.32–0.25).
Conclusions
EIT shows distinct differences in ventilation distribution between preterm and term-born infants, which cannot be detected by MBW. Although preterm infants are capable of dynamically maintaining overall functional residual volume and ventilation distribution, they show some spatial differences from fullterm infants.
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References
Baraldi E, Filippone M (2007) Chronic lung disease after premature birth. N Engl J Med 357:1946–1955
Jobe AH, Bancalari E (2001) Bronchopulmonary dysplasia. Am J Respir Crit Care Med 163:1723–1729
Kinsella JP, Greenough A, Abman SH (2006) Bronchopulmonary dysplasia. Lancet 367:1421–1431
Gappa M, Pillow JJ, Allen J, Mayer O, Stocks J (2006) Lung function tests in neonates and infants with chronic lung disease: lung and chest-wall mechanics. Pediatr Pulmonol 41:291–317
Hulskamp G, Pillow JJ, Dinger J, Stocks J (2006) Lung function tests in neonates and infants with chronic lung disease of infancy: functional residual capacity. Pediatr Pulmonol 41:1–22
Pillow JJ, Frerichs I, Stocks J (2006) Lung function tests in neonates and infants with chronic lung disease: global and regional ventilation inhomogeneity. Pediatr Pulmonol 41:105–121
Friedrich L, Pitrez PM, Stein RT, Goldani M, Tepper R, Jones MH (2007) Growth rate of lung function in healthy preterm infants. Am J Respir Crit Care Med 176:1269–1273
Hjalmarson O, Sandberg K (2002) Abnormal lung function in healthy preterm infants. Am J Respir Crit Care Med 165:83–87
Schmalisch G, Wilitzki S, Wauer RR (2005) Differences in tidal breathing between infants with chronic lung diseases and healthy controls. BMC Pediatr 5:36
Ochiai M, Hikino S, Yabuuchi H, Nakayama H, Sato K, Ohga S, Hara T (2008) A new scoring system for computed tomography of the chest for assessing the clinical status of bronchopulmonary dysplasia. J Pediatr 152:90–95, 95 e91–93
Dunlop S, Hough J, Riedel T, Fraser JF, Dunster K, Schibler A (2006) Electrical impedance tomography in extremely prematurely born infants and during high frequency oscillatory ventilation analyzed in the frequency domain. Physiol Meas 27:1151–1165 Epub 2006 Sep 1120
Frerichs I, Dargaville PA, Dudykevych T, Rimensberger PC (2003) Electrical impedance tomography: a method for monitoring regional lung aeration and tidal volume distribution? Intensive Care Med 29:2312–2316 Epub 2003 Oct 2318
Riedel T, Richards T, Schibler A (2005) The value of electrical impedance tomography in assessing the effect of body position and positive airway pressures on regional lung ventilation in spontaneously breathing subjects. Intensive Care Med 31:1522–1528 Epub 2005 Sep 1530
Frerichs I, Schiffmann H, Oehler R, Dudykevych T, Hahn G, Hinz J, Hellige G (2003) Distribution of lung ventilation in spontaneously breathing neonates lying in different body positions. Intensive Care Med 29:787–794 Epub 2003 Mar 2029
Hedenstierna G (2004) Using electric impedance tomography to assess regional ventilation at the bedside. Am J Respir Crit Care Med 169:777–778
Hjalmarson O, Sandberg KL (2005) Lung function at term reflects severity of bronchopulmonary dysplasia. J Pediatr 146:86–90
de Winter JP, Merth IT, Brand R, Quanjer PH (2000) Functional residual capacity and static compliance during the first year in preterm infants treated with surfactant. Am J Perinatol 17:377–384
Bates JH, Schmalisch G, Filbrun D, Stocks J (2000) Tidal breath analysis for infant pulmonary function testing. ERS/ATS task force on standards for infant respiratory function testing. European respiratory society/American thoracic society. Eur Respir J 16:1180–1192
Frey U, Stocks J, Coates A, Sly P, Bates J (2000) Specifications for equipment used for infant pulmonary function testing. ERS/ATS task force on standards for infant respiratory function testing. European respiratory society/American thoracic society. Eur Respir J 16:731–740
Friedrich L, Stein RT, Pitrez PM, Corso AL, Jones MH (2006) Reduced lung function in healthy preterm infants in the first months of life. Am J Respir Crit Care Med 173:442–447
Hulskamp G, Stocks J, Costeloe K, Hawdon S, Lum S, Hoo AF, Ljungberg H, Pillow JJ (2003) Interpretation of FRC in infants with CLD demands appropriate adjustment for body size. Eur Respir J 22(Suppl 45):382s [abstract]
Latzin P, Roth S, Thamrin C, Roiha HL, Baldwin D, Kuehni CE, Pramana I, Casaulta C, Riedel T, Frey U (2008) Tidal breathing and lung function abnormalities in preterm infants in comparison to term controls. Am J Respir Crit Care Med 177:A55
Latzin P, Kuehni CE, Baldwin DN, Roiha HL, Casaulta C, Frey U (2006) Elevated exhaled nitric oxide in newborns of atopic mothers precedes respiratory symptoms. Am J Respir Crit Care Med 174:1292–1298
Barber DC, Brown DH (1984) Applied potential tomography. J Phys E Sci Instrum 17:723–733
Latzin P, Sauteur L, Thamrin C, Schibler A, Baldwin D, Hutten GJ, Kyburz M, Kraemer R, Riedel T, Frey U (2007) Optimized temperature and deadspace correction improve analysis of multiple breath washout measurements by ultrasonic flowmeter in infants. Pediatr Pulmonol 42:888–897
Bland JM, Altman DG (1986) Statistical methods for assessing agreement between two methods of clinical measurement. Lancet 1:307–310
Wolf GK, Grychtol B, Frerichs I, van Genderingen HR, Zurakowski D, Thompson JE, Arnold JH (2007) Regional lung volume changes in children with acute respiratory distress syndrome during a derecruitment maneuver. Crit Care Med 35:1972–1978
Hinz J, Gehoff A, Moerer O, Frerichs I, Hahn G, Hellige G, Quintel M (2007) Regional filling characteristics of the lungs in mechanically ventilated patients with acute lung injury. Eur J Anaesthesiol 24:414–424
van Genderingen HR, van Vught AJ, Jansen JR (2004) Regional lung volume during high-frequency oscillatory ventilation by electrical impedance tomography. Crit Care Med 32:787–794
Meier T, Luepschen H, Karsten J, Leibecke T, Grossherr M, Gehring H, Leonhardt S (2008) Assessment of regional lung recruitment and derecruitment during a PEEP trial based on electrical impedance tomography. Intensive Care Med 34:543–550
Frerichs I, Hinz J, Herrmann P, Weisser G, Hahn G, Dudykevych T, Quintel M, Hellige G (2002) Detection of local lung air content by electrical impedance tomography compared with electron beam CT. J Appl Physiol 93:660–666
Victorino JA, Borges JB, Okamoto VN, Matos GF, Tucci MR, Caramez MP, Tanaka H, Sipmann FS, Santos DC, Barbas CS, Carvalho CR, Amato MB (2004) Imbalances in regional lung ventilation: a validation study on electrical impedance tomography. Am J Respir Crit Care Med 169:791–800
Hinz J, Neumann P, Dudykevych T, Andersson LG, Wrigge H, Burchardi H, Hedenstierna G (2003) Regional ventilation by electrical impedance tomography: a comparison with ventilation scintigraphy in pigs. Chest 124:314–322
Heinrich S, Schiffmann H, Frerichs A, Klockgether-Radke A, Frerichs I (2006) Body and head position effects on regional lung ventilation in infants: An electrical impedance tomography study. Intensive Care Med 32:1392–1398 Epub 2006 Jun 1324
Frerichs I, Schmitz G, Pulletz S, Schadler D, Zick G, Scholz J, Weiler N (2007) Reproducibility of regional lung ventilation distribution determined by electrical impedance tomography during mechanical ventilation. Physiol Meas 28:S261–S267
Katz-Salamon M, Jonsson B, Lagercrantz H (1995) Blunted peripheral chemoreceptor response to hyperoxia in a group of infants with bronchopulmonary dysplasia. Pediatr Pulmonol 20:101–106
Williams BA, Smyth J, Boon AW, Hanson MA, Kumar P, Blanco CE (1991) Development of respiratory chemoreflexes in response to alternations of fractional inspired oxygen in the newborn infant. J Physiol 442:81–90
Crawford AB, Makowska M, Engel LA (1986) Effect of tidal volume on ventilation maldistribution. Respir Physiol 66:11–25
Milic-Emili J, Henderson JA, Dolovich MB, Trop D, Kaneko K (1966) Regional distribution of inspired gas in the lung. J Appl Physiol 21:749–759
Helms P, Beardsmore CS, Stocks J (1981) Absolute intraesophageal pressure at functional residual capacity in frequency. J Appl Physiol 51:270–275
Acknowledgments
This study was supported, in parts, by the Swiss National Foundation grant 3200-B0-112099 to P.L. and U.F.
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Riedel, T., Kyburz, M., Latzin, P. et al. Regional and overall ventilation inhomogeneities in preterm and term-born infants. Intensive Care Med 35, 144–151 (2009). https://doi.org/10.1007/s00134-008-1299-x
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DOI: https://doi.org/10.1007/s00134-008-1299-x