An intercostal retractometer for estimation of intrapleural pressure changes in infants

An intercostal retractometer was developed for estimation of intrapleural pressure changes in infants. It consists of a flat reference plate which floats over the interspace and is attached to the skin by a flexible plastic film. The pressure inside the device is measured with a strain gauge. The volume inside the device is adjusted, so that the intercostal space is brought to a condition of flatness and pressure changes in the device correlate linearly with intrapleural pressure changes. The retractometer is calibrated against overall intrapleural pressure changes by matching its output to changes in airway pressure during occlusion of the airway. The calibration factor is qualitatively proportional to the thickness of the subcutaneous tissue. Retractometer and intrapleural pressures were simultaneously measured in two infant rhesus monkeys with small pneumothoraces. Esophageal and retractometer pressures were compared in seven preterm infants with an average weight of 1345 g. The device estimated the monkeys' intrapleural pressure changes to within 1.2 cmH2O and the human preterm infants' esophageal pressure changes to within 1.3 cmH2O (95% confidence limits of a linear regression).