Plethysmograph and interrupter resistance measurements in prematurely born young children.

BACKGROUND: Airways obstruction in premature infants is often assessed by plethysmography, which requires sedation. The interrupter (Rint) technique does not require sedation, but has rarely been examined in children under 2 years of age. OBJECTIVE: To compare Rint results with plethysmographic measurements of airway resistance (Raw) in prematurely born, young children. DESIGN: Prospective study. SETTING: Infant and Paediatric Lung Function Laboratories. PATIENTS: Thirty children with a median gestational age of 25-29 weeks and median postnatal age of 13 months. INTERVENTIONS AND MAIN OUTCOME MEASURES: The infants were sedated, airway resistance was measured by total body plethysmography (Raw), and Rint measurements were made using a MicroRint device. Further Raw and Rint measurements were made after salbutamol administration if the children remained asleep. RESULTS: Baseline measurements of Raw and Rint were obtained from 30 and 26 respectively of the children. Mean baseline Rint values were higher than mean baseline Raw results (3.45 v 2.84 kPa/l/s, p = 0.006). Limits of agreement for the mean difference between Rint and Raw were -1.52 to 2.74 kPa/l/s. Ten infants received salbutamol, after which the mean Rint result was 3.6 kPa/l/s and mean Raw was 3.1 kPa/l/s (limits of agreement -0.28 to 1.44 kPa/l/s). CONCLUSION: The poor agreement between Rint and Raw results suggests that Rint measurements cannot substitute for plethysmographic measurements in sedated prematurely born infants.

Lung sounds in neonates with and without an added dead space.

Previous studies have reported great difficulty in recording lung sounds from neonates and have found conflicting results. We studied lung sounds in neonates during the inspiratory phase of the respiratory cycle as monitored by inductive plethysmography (A) and by a pneumotachograph and a face mask (B) which added a dead space of 12 mL. Sixteen term babies were tested 12 hr to 6 days (median 45 hours) after birth. Lung sounds were recorded and then analysed using overlapping and non-overlapping fast Fourier transforms. The two methods of analysis showed a difference in intensity but not in frequency. Fourteen babies provided enough breaths for comparison; a total of 596 inspirations were analysed. The intensity of lung sounds on occasion B was higher in all but two babies with a mean B/A ratio of 2.4. The mean (SD) power on occasions A and B was 13.9 (8.5) mW and 26.9 (21.0) mW, P = 0.02, respectively. In all but 4 babies the B/A ratios of the median (f50) and 90th centile (f90) frequencies were scattered randomly within 20% of unity. The mean (SD) f50 on occasions A and B was 205.5 (51.1) Hz and 225.8 (32.3) Hz, P = 0.10, respectively; the mean f90 was 370.3 (91.0) Hz and 396.1 (67.8) Hz, P = 0.25, respectively. Linear regression showed that there is a third-order polynomial relationship between sound intensity and air flow at the mouth. A weaker positive association exists between frequency and air flow, showing that the median and 90th centile frequencies approach an asymptote as flow increases.(ABSTRACT TRUNCATED AT 250 WORDS)

Determination of resonance frequency of the respiratory system in respiratory distress syndrome.

AIM: To measure tidal volume delivery produced by high frequency oscillation (HFO) at a range of frequencies including the resonance frequency. METHODS: Eighteen infants with respiratory distress syndrome were recruited (median gestation 28.7 weeks). Each was ventilated at frequencies between 8 and 30 Hertz. Phase analysis was performed at various points of the respiratory cycle. HFO was provided by a variable speed piston device. Resonance frequency was determined from the phase relation between the cyclical movements of the piston and pressure changes at the airway opening. Tidal volume was measured using a jacket plethysmograph. RESULTS: The results were most reproducible when analysis was performed at the end of inspiration (within 1 Hz in nine out of 10 cases). Comparison between tidal volume delivery at 10 Hz and resonance frequency was made in 10 subjects. Delivery was significantly higher at resonance than at 10 Hertz (mean percentage increase 92%, range 9-222%). CONCLUSIONS: These preliminary findings suggest that there is improved volume delivery at resonance frequency.

Application of 3-D computer graphics for facial reconstruction and comparison with sculpting techniques.

Facial reconstruction has until now been carried out by the sculpting technique. This method involves building a face with clay or other suitable material on to a skull or its cast, taking into account appropriate facial thickness measurements together with information provided by anthropologists such as approximate age, sex, race and other individual idiosyncrasies. A method for facial reconstruction is presented using 3-D computer graphics and is compared with the manual technique. The computer method involves initially digitising a skull using a laser scanner and video camera interfaced to a computer. A face, from a data bank which has previously digitised facial surfaces, is then placed over the skull in the form of a mask and the skin thickness is altered to conform with the underlying skull. The advantage of the computer method is its speed and flexibility. We have shown that the computer method for reconstructing a face is feasible and furthermore has the advantage over the manual technique of speed and flexibility. Nevertheless, the technique is far from perfect. Further facial thickness data needs collecting and the method requires evaluation using both known control skulls and later unknown remains.

Airway resistance estimation by best fit analysis in very premature infants.

Plethysmographic measurement of airway resistance (R(aw)) has been determined by single-point analysis, usually at 50% of maximum inspiratory flow (MIF). Computer-assisted (best fit) analysis, however, allows R(aw) to be calculated by applying a regression line to any portion of the plethysmograph pressure-flow loop. We determined whether the results of best fit analysis using a computer program, sampling at 200 Hz, were influenced by the portion of the inspiratory loop analysed and if best fit or single-point analysis gave more reproducible results. Twenty infants of median gestational age 26 (range 24-28) weeks, were studied at a median age of 12 (12-14) months corrected for prematurity. R(aw) was calculated by best fit analysis between 0 and 33% MIF, 0 and 50% MIF and 0 and 67% MIF and single-point analysis at 50% of MIF. Similar mean R(aw) values were obtained by best fit analysis between 0 and 33% MIF (2.79 kPa/(l/s)) and 0 and 50% MIF (3.01 kPa/(l/s)) and single-point analysis at 50% MIF (2.86 kPa/(l/s)), but best fit analysis between 0 and 67% gave higher results (3.60 kPa/(l/s)), p < 0.0001. Within the linear portion of the inspiratory loop, the mean intrasubject coefficient of variation was lowest for best fit analysis between 0 and 50% MIF. Best fit computerized analysis between 0 and 50% MIF is recommended as the analysis of choice.

Phase analysis in high-frequency oscillation.

UNLABELLED: In an oscillating system driven by a sine wave pump, the resonance frequency of the respiratory system can be determined using phase analysis. At resonance frequency, when elastance and inertance cancel out, flow becomes in-phase with resistance. In premature infants with respiratory distress syndrome, owing to surfactant deficiency, localized areas of hyperinflation and collapse develop, resulting in complex changes in overall pulmonary mechanics. We investigated the effect of measuring resonance frequency of the respiratory system by phase analysis at different points of the respiratory cycle: end of inspiration, end of expiration, mid-inspiration and mid-expiration. Ten ventilated premature infants with respiratory distress syndrome were studied, gestational age ranged from 24 to 30 weeks (mean 27.6 weeks) and birth weight ranged from 0.7 to 1.505 kg (mean 0.984 kg). RESULTS: The resonance frequency was consistently higher when measured at the end of inspiration compared with the end of expiration. The expected trend of phase variation, that is, negative below the resonance frequency and positive above, was most consistently found when analysis was done at the end of inspiration. CONCLUSIONS: These findings were most likely a result of the complexity of pulmonary mechanics in the surfactant-deficient lungs, rendering the single compartment model we based our theory on inadequate. However, phase analysis performed at the end of inspiration seemed to produce the most reliable and consistent results.

Application of 3-D computer graphics for facial reconstruction and comparison with sculpting techniques

Facial reconstruction has until now been carried out by the sculpting technique. This method involves building a face with clay or other suitable material on to a skull or its cast, taking into account appropriate facial thickness measurements together with information provided by anthropologists such as approximate age, race and other individual indiosyncrasies. Nevertheless, the technique is far from perfect. Further facial thickmess data needs collecting and the method requires evaluation using both known control skulls and later unknown remains (AU)