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Investigation into Deep Breathing through Measurement of Ventilatory Parameters and Observation of Breathing Patterns
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Investigation into Deep Breathing through Measurement of Ventilatory Parameters and Observation of Breathing Patterns

Published on: September 16, 2019

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Diaphragmatic activity and neural breathing variability during a 5-min endotracheal continuous positive airway

Samantha Latremouille1, Monica Bhuller1, Smita Rao2

  • 1Division of Experimental Medicine, McGill University Health Center, Montreal, QC, Canada.

Pediatric Research
|September 17, 2020
PubMed

Insights

Endotracheal tube continuous positive airway pressure (ETT-CPAP) trials in extremely preterm infants increase diaphragmatic activity and alter breathing variability, indicating a significant respiratory load. Further research is needed before clinical recommendations for ETT-CPAP trials can be made.

Area of Science:

  • Neonatal Physiology
  • Respiratory Medicine
  • Pediatric Critical Care

Background:

  • Extremely preterm infants often undergo endotracheal tube continuous positive airway pressure (ETT-CPAP) trials to evaluate extubation readiness.
  • The impact of ETT-CPAP trials on diaphragmatic activity and breathing variability in these vulnerable infants remains largely uncharacterized.

Purpose of the Study:

  • To investigate the effects of ETT-CPAP trials on diaphragmatic electrical activity (Edi) and neural breathing variability in extremely preterm infants.
  • To compare respiratory parameters during mechanical ventilation (MV) versus ETT-CPAP.

Main Methods:

  • A prospective observational study included 13 extremely preterm infants (birth weight ≤1250g) during their first extubation attempt.
  • Diaphragmatic activity (Edi min, Edi max, signal area) and breath-by-breath parameters (area, amplitude, width, neural inspiratory/expiratory times) were analyzed during MV and ETT-CPAP.
  • Neural breathing variability was calculated and compared between the two ventilation modes.

Main Results:

  • Infants showed significantly increased diaphragmatic activity (Edi max, breath area, amplitude) during ETT-CPAP compared to MV.
  • Neural breathing variability during ETT-CPAP exhibited increased variability in amplitude and area, with decreased variability in breath time and width.
  • Differences in breathing variability were noted between successful and failed extubations.

Conclusions:

  • A 5-minute ETT-CPAP trial imposes a significant respiratory load on extremely preterm infants, evidenced by increased diaphragmatic activity and altered breathing variability.
  • While infants demonstrate a response to ETT-CPAP, its clinical utility for extubation readiness requires further investigation and standardization.
  • Current evidence does not support routine clinical recommendation of ETT-CPAP trials for preterm infants without established standards.
Abstract

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