Pulmonary function in technology-dependent children 2 years and older with bronchopulmonary dysplasia.
Somatic and pulmonary growth coincide with resolution of hypoxemia by 2 years of age in most children with bronchopulmonary dysplasia (BPD). However, a distinct subgroup of children with BPD continue to require mechanical ventilation and/or supplemental oxygen beyond 2 years of age. This study tested the hypothesis that indices of pulmonary function would be significantly worse in children with BPD 2 years and older who remained technology-dependent secondary to hypoxemia, compared to those of age-matched children with BPD who were normoxemic. We measured pulmonary mechanics in 21 oxygen- or ventilator-dependent children with BPD 2 years and older (BPDO2 group; mean age+/-SD, 30.2+/-6.5 months) and in 19 children with BPD who had been weaned off mechanical ventilation and supplemental oxygen for at least 6 months (control group; mean age, 30.1+/-5.5 months). Respiratory rate and tidal volume were measured after sedation with chloral hydrate, and dynamic compliance and expiratory conductance were calculated using the esophageal catheter technique. Maximal flow at FRC (V'(maxFRC)) and ratio of forced-to-tidal flows at midtidal volume were obtained by the rapid thoracic compression technique. FRC was determined by nitrogen washout. There were no statistically significant differences in most measured indices of pulmonary mechanics between the BPDO2 and control groups. However, V'(maxFRC)/FRC was higher in controls compared to subjects in the BPDO2 group (0.81+/-0.40 sec(-1) vs. 0.34+/-0.21 sec(-1), P<0.003). We conclude that most indices of pulmonary function in children with BPD 2 years and older do not reflect the need for mechanical ventilation or supplemental oxygen. We speculate that measurements of lung elastic recoil and tests of distribution of ventilation and pulmonary perfusion may be more sensitive in differentiating normoxemic and hypoxemic children with BPD 2 years and older.
Talmaciu
Isaac
I
Division of Pediatric Pulmonology, St. Christopher's Hospital for Children, Philadelphia, Pennsylvania, USA. italmaciu@aol.com
Ren
Clement L
CL
Kolb
Susan M
SM
Hickey
Eileen
E
Panitch
Howard B
HB
D001997:Bronchopulmonary Dysplasia / Q000150:complications / Q000503:physiopathology* / Q000628:therapy; D002675:Child, Preschool; D005260:Female; D005540:Forced Expiratory Flow Rates; D005652:Functional Residual Capacity; D006801:Humans; D000860:Hypoxia / Q000209:etiology / Q000503:physiopathology* / Q000628:therapy; D007231:Infant, Newborn; D008297:Male; D010102:Oxygen Inhalation Therapy; D012121:Respiration, Artificial; D012129:Respiratory Function Tests; D015656:Respiratory Mechanics; D013990:Tidal Volume