Effort and work-of-breathing parameters strongly correlate with increased resistance in an animal model

Rutger C Flink; Christopher J L Newth; Justin C Hotz; Martin C J Kneyber; Patrick A Ross; Frans H de Jongh; Anton H van Kaam; Robinder G Khemani

doi:10.1038/s41390-023-02576-4

Effort and work-of-breathing parameters strongly correlate with increased resistance in an animal model

Pediatr Res. 2023 Sep;94(3):944-949. doi: 10.1038/s41390-023-02576-4. Epub 2023 Mar 28.

Authors

Rutger C Flink¹, Christopher J L Newth^{2

3}, Justin C Hotz^{2

3}, Martin C J Kneyber⁴, Patrick A Ross², Frans H de Jongh⁵, Anton H van Kaam⁵, Robinder G Khemani^{2

3}

Affiliations

¹ Department of Neonatology, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands. r.flink@medelink.nl.
² Department of Anesthesiology & Critical Care Medicine, Children's Hospital Los Angeles, Los Angeles, CA, USA.
³ Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
⁴ Department of Paediatrics, Division of Paediatric Critical Care Medicine, Beatrix Children's Hospital Groningen, University Medical Center Groningen, The University of Groningen, Groningen, The Netherlands.
⁵ Department of Neonatology, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.

PMID: 36977768
DOI: 10.1038/s41390-023-02576-4

Abstract

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 (WOB_SPIR) or RIP flow (WOB_RIP).

Results: WOB, PRP and PTP showed similar linear increases when exposed to higher levels of resistive loads. When comparing WOB_SPIR to WOB_RIP, 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.

Publication types

Research Support, Non-U.S. Gov't
Research Support, N.I.H., Extramural

MeSH terms

Animals
Models, Animal
Positive-Pressure Respiration* / methods
Primates
Respiration*
Work of Breathing