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Spirometric and endoscopic evaluation of airway collapse in infants with bronchopulmonary dysplasia
K S McCoy1, C E Bagwell, M Wagner
1Department of Pediatrics, College of Medicine, University of Florida, J. Hillis Miller Health Center, Gainesville.
Insights
Infants with bronchopulmonary dysplasia experiencing respiratory distress during agitation may have tracheal collapse. Calming or sedation effectively resolved these episodes, suggesting a link between agitation and airway instability.
Area of Science:
- Pediatric Pulmonology
- Neonatology
- Respiratory Physiology
Background:
- Bronchopulmonary dysplasia (BPD) is a chronic lung disease in infants.
- Infants with BPD often experience respiratory deterioration, complicating ventilation weaning.
- Agitation-induced respiratory events pose a significant challenge in managing BPD.
Purpose of the Study:
- To investigate the cause of recurrent respiratory deterioration in infants with BPD during agitation.
- To assess the association between agitation, expiratory airflow, and tracheal dynamics.
- To determine the efficacy of calming or sedation in resolving these episodes.
Main Methods:
- Evaluation of eight infants (2-13 months) with BPD and recurrent respiratory deterioration.
- Spirometric evaluation during simulated agitation.
- Endoscopic examination during simulated agitation in six infants.
- Monitoring of expiratory airflow patterns, muscle activity, and oxygen saturation.
Main Results:
- All infants exhibited a prolonged, near-zero expiratory airflow pattern during agitation.
- Six infants demonstrated endoscopically confirmed tracheal collapse during simulated agitation.
- Agitation led to vigorous diaphragmatic/abdominal muscle activity and rapid hypoxia.
- Episodes resolved with calming or sedation.
Conclusions:
- Agitation can trigger significant expiratory airflow limitation and tracheal collapse in infants with BPD.
- Tracheal instability during agitation is a potential cause of respiratory deterioration in BPD.
- Non-pharmacological interventions like calming or sedation can effectively manage these episodes.
Abstract:
We evaluated eight infants with bronchopulmonary dysplasia (BPD) at ages from 2 to 13 months who had repeated episodes of clinical respiratory deterioration associated with agitation. These episodes limited further weaning from ventilation or necessitated recurrent intubation and reinstitution of ventilation. All infants underwent spirometric evaluation and six also had endoscopic examination during simulated agitation episodes (elicited by toe pinching). All babies were found to have a very prolonged near zero expiratory airflow pattern, accompanied by vigorous diaphragmatic and abdominal muscle activity and rapid development of hypoxia. Six patients had endoscopically documented tracheal collapse under the same simulated circumstances. The episodes ceased with calming or sedation of the infants.