TY - JOUR
T1 - Effort and work-of-breathing parameters strongly correlate with increased resistance in an animal model
AU - Flink, Rutger C.
AU - Newth, Christopher J. L.
AU - Hotz, Justin C.
AU - Kneyber, Martin C. J.
AU - Ross, Patrick A.
AU - de Jongh, Frans H.
AU - van Kaam, Anton. H.
AU - Khemani, Robinder G.
N1 - Funding Information: The authors acknowledge the financial support of the National Institutes of Health/National Institutes of Child Health and Development 1K23HL103785 (R.G.K.), Bethesda, MD, and Novartis Pharmaceutical Grant-in-Aid for facilities (C.J.L.N.), Basel, Switzerland. Publisher Copyright: © 2023, The Author(s), under exclusive licence to the International Pediatric Research Foundation, Inc.
PY - 2023/9
Y1 - 2023/9
N2 - Background: Effort of Breathing (EOB) calculations may be a reliable alternative to Work of Breathing (WOB) calculations in which Respiratory Inductance Plethysmography (RIP) replaces spirometry. We sought to compare EOB and WOB measurements in a nonhuman primate model of increasing extrathoracic inspiratory resistance simulating upper airway obstruction (UAO). Methods: RIP, spirometry, and esophageal manometry were measured in spontaneously breathing, intubated Rhesus monkeys utilizing 11 calibrated resistors randomly applied for 2-min. EOB was calculated breath-by-breath as Pressure Rate Product (PRP) and Pressure Time Product (PTP). WOB was calculated from the Pressure-Volume curve based on spirometry (WOBSPIR) or RIP flow (WOBRIP). Results: WOB, PRP and PTP showed similar linear increases when exposed to higher levels of resistive loads. When comparing WOBSPIR to WOBRIP, a similar strong correlation was seen for both signals as resistance increased and there were no statistically significant differences. Conclusion: EOB and WOB parameters utilizing esophageal manometry and RIP, independent of spirometry, showed a strong correlation as a function of increasing inspiratory resistance in nonhuman primates. This allows several potential monitoring possibilities for non-invasively ventilated patients or situations where spirometry is not available. Impact: EOB and WOB parameters showed a strong correlation as a function of increasing inspiratory resistance in nonhuman primates.There was a strong correlation between spirometry-based WOB versus RIP-based WOB.To date, it has remained untested as to whether EOB is a reliable alternative for WOB and if RIP can replace spirometry in these measurements.Our results enable additional potential monitoring possibilities for non-invasively ventilated patients or situations where spirometry is not available.Where spirometry is not available, there is no need to apply a facemask post extubation to a spontaneously breathing, non-intubated infant to make objective EOB measurements.
AB - Background: Effort of Breathing (EOB) calculations may be a reliable alternative to Work of Breathing (WOB) calculations in which Respiratory Inductance Plethysmography (RIP) replaces spirometry. We sought to compare EOB and WOB measurements in a nonhuman primate model of increasing extrathoracic inspiratory resistance simulating upper airway obstruction (UAO). Methods: RIP, spirometry, and esophageal manometry were measured in spontaneously breathing, intubated Rhesus monkeys utilizing 11 calibrated resistors randomly applied for 2-min. EOB was calculated breath-by-breath as Pressure Rate Product (PRP) and Pressure Time Product (PTP). WOB was calculated from the Pressure-Volume curve based on spirometry (WOBSPIR) or RIP flow (WOBRIP). Results: WOB, PRP and PTP showed similar linear increases when exposed to higher levels of resistive loads. When comparing WOBSPIR to WOBRIP, a similar strong correlation was seen for both signals as resistance increased and there were no statistically significant differences. Conclusion: EOB and WOB parameters utilizing esophageal manometry and RIP, independent of spirometry, showed a strong correlation as a function of increasing inspiratory resistance in nonhuman primates. This allows several potential monitoring possibilities for non-invasively ventilated patients or situations where spirometry is not available. Impact: EOB and WOB parameters showed a strong correlation as a function of increasing inspiratory resistance in nonhuman primates.There was a strong correlation between spirometry-based WOB versus RIP-based WOB.To date, it has remained untested as to whether EOB is a reliable alternative for WOB and if RIP can replace spirometry in these measurements.Our results enable additional potential monitoring possibilities for non-invasively ventilated patients or situations where spirometry is not available.Where spirometry is not available, there is no need to apply a facemask post extubation to a spontaneously breathing, non-intubated infant to make objective EOB measurements.
UR - http://www.scopus.com/inward/record.url?scp=85151127435&partnerID=8YFLogxK
U2 - https://doi.org/10.1038/s41390-023-02576-4
DO - https://doi.org/10.1038/s41390-023-02576-4
M3 - Article
C2 - 36977768
SN - 0031-3998
VL - 94
SP - 944
EP - 949
JO - Pediatric Research
JF - Pediatric Research
IS - 3
ER -