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Increased respiratory drive and limited adaptation to loaded breathing in bronchopulmonary dysplasia
J S Greenspan1, M R Wolfson, R G Locke
1Department of Pediatrics, Temple University School of Medicine, Temple University Hospital, Philadelphia, Pennsylvania 19140.
Insights
Infants with bronchopulmonary dysplasia (BPD) show increased respiratory drive but have a limited ability to adapt to acute breathing challenges. This suggests reduced ventilatory reserve in infants with BPD.
Area of Science:
- Neonatology
- Pediatric Pulmonology
- Respiratory Physiology
Background:
- Bronchopulmonary dysplasia (BPD) is a chronic lung disease in preterm infants.
- Infants with BPD often experience increased work of breathing due to intrinsic lung abnormalities.
- Assessing respiratory drive and ventilatory response is crucial for managing these infants.
Purpose of the Study:
- To compare ventilatory parameters and respiratory drive between healthy preterm infants and those with BPD.
- To evaluate the response to an acute external resistive load in both groups.
- To understand the implications for ventilatory reserve in infants with BPD.
Main Methods:
- Esophageal manometry and pneumotachography were used to measure lung mechanics.
- Respiratory drive was assessed by occluding the airway and measuring inspiratory pressure.
- Infants were studied at rest and with an added inspiratory resistive load.
Main Results:
- Infants with BPD exhibited lower compliance, higher resistance, and increased baseline respiratory drive compared to healthy preterm infants.
- Healthy preterm infants increased their respiratory drive in response to the load, while BPD infants did not.
- Both groups showed decreased ventilation with the load, but the reduction was greater in infants with BPD.
Conclusions:
- Infants with BPD have an increased respiratory drive, likely a response to chronic intrinsic lung loading.
- This increased drive may compromise their ventilatory reserve.
- BPD infants demonstrate a limited ability to adapt to acute pulmonary challenges, highlighting potential risks.
Abstract:
Ventilatory parameters and respiratory drive with and without an added acute resistive load were assessed in 11 healthy preterm infants and 11 infants with bronchopulmonary dysplasia (BPD). Lung mechanics (breathing frequency, tidal volume, minute ventilation, compliance, and resistance) were determined with esophageal manometry and pneumotachography. Respiratory drive was assessed by determining the airway pressure measured 100 ms after the onset of an inspiratory effort against an occlusion. Infants were studied at baseline and with an external inspiratory resistive load of 213.7 cm H2O/L/s. Infants with BPD had similar breathing frequency, tidal volume, and minute ventilation, lower compliance, and greater resistance and airway pressure at 100 ms than healthy preterm infants at rest. With loading, healthy preterm infants demonstrated increased airway pressure at 100 ms, whereas infants with BPD showed no change. Although the healthy preterm infants had decreased minute ventilation and tidal volume with loading, decreases in ventilation were greater in the infants with BPD. These data demonstrate that infants with BPD have responded to a chronic intrinsic load with increased drive. However, this may result in decreased ventilatory reserve and hence, a limited ability to adapt to acute pulmonary loads.