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Effects of CPAP on lung mechanics in infants with acquired tracheobronchomalacia
H B Panitch1, J L Allen, B E Alpert
1Department of Pediatrics, St. Christopher's Hospital for Children, Temple University School of Medicine, Philadelphia, Pennsylvania.
Insights
Continuous positive airway pressure (CPAP) helps infants with tracheobronchomalacia (TBM) by preventing airway collapse. CPAP significantly improved maximal expiratory flow, indicating its effectiveness in managing TBM complications.
Area of Science:
- Pediatric Pulmonology
- Respiratory Physiology
Background:
- Continuous positive airway pressure (CPAP) is used for tracheobronchomalacia (TBM) in infants.
- Its precise impact on lung mechanics in TBM patients remains unclear.
Purpose of the Study:
- To investigate the effects of CPAP on respiratory mechanics in infants with TBM.
- To determine if CPAP prevents airway collapse and enhances forced exhalation.
Main Methods:
- Nine infants with acquired TBM underwent respiratory mechanics assessments.
- Measurements included esophageal balloon and rapid thoracic compression techniques.
- Lung function was evaluated at baseline and with 5 and 8 cm H2O CPAP.
Main Results:
- Maximal expiratory flow at functional residual capacity (Vmax FRC) increased threefold with 8 cm H2O CPAP.
- No significant changes were observed in expiratory resistance (RL) or mid-expiratory tidal flow (VE50).
Conclusions:
- CPAP effectively prevents airway collapse during forced exhalation in infants with TBM.
- Maximal expiratory flow measurements are better indicators of CPAP efficacy than tidal mechanics in TBM.
Abstract:
Continuous positive airway pressure (CPAP) has been used in the treatment of infants with tracheobronchomalacia (TBM). However, the effects of CPAP on lung mechanics in these infants are unknown. We hypothesized that CPAP prevents airway collapse and improves forced exhalation. We studied respiratory mechanics of nine infants (age 15 +/- 3 mo, SEM) with acquired TBM documented by bronchoscopy, during quiet respiration and forced exhalation, using the esophageal balloon and rapid thoracic compression techniques, respectively. Measurements were made when infants received no CPAP and repeated when 5 and 8 cm H2O CPAP were applied to the airway opening via a modified Mapleson anesthesia circuit. Expiratory resistance (RL), midexpiratory tidal flow (VE50), and maximal flow at functional residual capacity (Vmax FRC) were compared at each level of CPAP. Vmax FRC increased threefold from baseline to 8 cm H2O CPAP (p < 0.005). In contrast, there was no difference in expiratory RL or in VE50 at any level of CPAP. These data suggest that in infants with acquired TBM, assessments of forced expiratory flow reflect the amount of CPAP necessary to prevent airway collapse during forced exhalation better than can measurements of tidal mechanics.