title: Influence of jacket placement on respiratory compliance during raised lung volume measurements in infants.
abstract: SUMMARY. Recent introduction of the raised lung volume rapid thoraco-abdominal compression (RVRTC) technique for measuring forced expiratory maneuvers in infants provides the potential opportunity to assess respiratory mechanics simultaneously by using multiple linear regression (MLR) of the relaxed breaths preceding jacket inflation to force expiration. This study was undertaken to investigate whether data obtained from raised lung volume are influenced by placement of the rapid thoraco-abdominal compression (RTC) squeeze jacket. Paired measurements of tidal volume (V(T)) and respiratory rate (RR) during tidal breathing, and of inflation volume (V(inf)), respiratory system compliance (C(rs)), and resistance (R(rs)) during passive lung inflations were made in 60 (30 male) healthy term infants with and without a fastened, but uninflated RTC jacket in place. Jacket placement was associated with a significant reduction (P < 0.0001) in weight-corrected V(inf) [-1.86 (95% confidence interval, -2.46, -1.27) mL.kg(-1)] and C(rs) [-0.77 (-1.04, -0.49) mL.kPa(-1).kg(-1)]. This represented a reduction in weight-corrected C(rs) from 9.00 to 8.24 mL.kPa(-1).kg(-1), with the fall being >10% in 42% of infants studied. There was no significant change in R(rs) or weight-corrected V(T). If passive respiratory mechanics are to be measured during raised lung volume maneuvers, they should be performed prior to the jacket being fastened, unless considerable care is taken with each infant to ensure that the jacket does not restrict chest wall movement during maximum inflation.
authors.affiliation: Portex Anaesthesia, Intensive Therapy and Respiratory Medicine Unit, Institute of Child Health and Great Ormond Street Hospital for Children NHS Trust, 30 Guilford Street, London WC1N 1EH, United Kingdom. a.hoo@ich.ucl.ac.uk
authors.forename: A F
authors.initials: AF
authors.lastname: Hoo
authors.forename: S Y
authors.initials: SY
authors.lastname: Lum
authors.forename: I
authors.initials: I
authors.lastname: Goetz
authors.forename: C
authors.initials: C
authors.lastname: Dezateux
authors.forename: J
authors.initials: J
authors.lastname: Stocks
mesh_terms: D000403:Airway Resistance / Q000502:physiology; D016001:Confidence Intervals; D004867:Equipment Design; D005260:Female; D005541:Forced Expiratory Volume / Q000502:physiology*; D006801:Humans; D007223:Infant; D007320:Inspiratory Capacity / Q000502:physiology; D016014:Linear Models; D008170:Lung Compliance / Q000502:physiology; D008176:Lung Volume Measurements / Q000295:instrumentation*; D008297:Male; D011312:Pressure; D012123:Pulmonary Ventilation / Q000502:physiology; D012119:Respiration; D015656:Respiratory Mechanics / Q000502:physiology*; D013990:Tidal Volume / Q000502:physiology