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Inspiratory Effort and Dynamic Transpulmonary Driving Pressure in Extremely Preterm Infants

Daniele De Luca1, Sofia De La Rubia1, Francesca Miselli2

  • 1Division of Pediatric and Neonatal Critical Care, "A.Béclère" Medical Center, APHP/Paris Saclay University, Paris, France; Physiopathology and Therapeutic Innovation Unit-INSERM U999, Paris Saclay University, Paris, France.

Chest
|October 11, 2025
PubMed

Insights

In preterm infants on noninvasive ventilation, inspiratory effort (ΔPes) and transpulmonary driving pressure (ΔPL) show significant variability. High ΔPes is more frequent in bronchopulmonary dysplasia (BPD), while high ΔPL occurs in both BPD and respiratory distress syndrome (RDS) and correlates with oxygenation impairment.

Area of Science:

  • Neonatology
  • Pediatric Critical Care
  • Respiratory Physiology

Background:

  • Data on inspiratory effort (ΔPes) and transpulmonary driving pressure (ΔPL) are limited in preterm infants on noninvasive ventilation.
  • Electrical activity of the diaphragm (EAdi) can estimate these pressures when patient size is a limitation.
  • This estimation may offer insights into respiratory pathophysiology and self-inflicted lung injury risk.

Purpose of the Study:

  • To characterize ΔPes and ΔPL in extremely preterm infants receiving noninvasive ventilation.

Main Methods:

  • Prospective, observational pilot cohort study.
  • Recorded EAdi in neonates with respiratory distress syndrome (RDS), evolving bronchopulmonary dysplasia (BPD), and term controls on noninvasive ventilation.
  • Estimated ΔPes and ΔPL using EAdi; measured diaphragmatic thickening fraction (TF) and SpO2/FiO2 in a subset.

Main Results:

  • Average EAdi, ΔPes, ΔPL, and TF were similar across groups.
  • Inter-patient variability of ΔPes and ΔPL was significantly higher in preterm infants (RDS and BPD) than controls.
  • High ΔPes was more frequent in BPD; high ΔPL was more frequent in RDS/BPD patients than controls and correlated inversely with SpO2/FiO2.

Conclusions:

  • ΔPes and ΔPL exhibit significant variability in preterm infants on noninvasive support.
  • High ΔPes is more prevalent in BPD, while high ΔPL is common in both RDS and BPD, indicating increased lung stress.
  • These findings highlight the potential for lung injury and the importance of monitoring respiratory mechanics in these vulnerable infants.
Abstract

Keywords:
diaphragmlunglung stressneonatenoninvasive ventilationpatient self-inflicted lung injury

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