Airway closure during mixed apneas in preterm infants: Is respiratory effort necessary?
Airway closure during mixed apneas in preterm infants may be due to lack of tone in the upper airway followed by collapse and obstruction or diaphragmatic action inducing obstruction. We examine whether respiratory efforts are necessary for airway closure using a new method of detecting airway obstr...
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| Veröffentlicht in: | The Journal of pediatrics 1998-10, Vol.133 (4), p.509-512 |
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| creator | Idiong, Nnanake Lemke, Robert P. Lin, Yuh-Jyh Kwiatkowski, Kim Cates, Don B. Rigatto, Henrique |
| description | Airway closure during mixed apneas in preterm infants may be due to lack of tone in the upper airway followed by collapse and obstruction or diaphragmatic action inducing obstruction. We examine whether respiratory efforts are necessary for airway closure using a new method of detecting airway obstruction, based on the disappearance of an amplified cardiac pulse observed on the respiratory flow tracing. We analyzed 198 episodes of mixed apnea of various lengths (≥3 seconds) observed in 33 preterm infants (birth weight, 1.4 ± 0.1 kg [mean ± SEM]; study weight, 1.7 ± 0.1 kg; gestational age, 29 ± 1 weeks; postnatal age, 33 ± 4 days). The great majority of these episodes (88%) had a central, followed by an obstructive, component. Infants were studied by using a nosepiece and a flow-through system. Respiratory efforts (abdominal and chest movements) were recorded. Of the apneas, 20 were |
| doi_str_mv | 10.1016/S0022-3476(98)70058-7 |
| format | Article |
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We examine whether respiratory efforts are necessary for airway closure using a new method of detecting airway obstruction, based on the disappearance of an amplified cardiac pulse observed on the respiratory flow tracing. We analyzed 198 episodes of mixed apnea of various lengths (≥3 seconds) observed in 33 preterm infants (birth weight, 1.4 ± 0.1 kg [mean ± SEM]; study weight, 1.7 ± 0.1 kg; gestational age, 29 ± 1 weeks; postnatal age, 33 ± 4 days). The great majority of these episodes (88%) had a central, followed by an obstructive, component. Infants were studied by using a nosepiece and a flow-through system. Respiratory efforts (abdominal and chest movements) were recorded. Of the apneas, 20 were <5 seconds; 78, 5 to <10 seconds; 45, 10 to <15 seconds; 27, 15 to <20 seconds; and 28, ≥20 seconds. Of the 198 mixed apneas, 151 (76%) occurred in the absence of any respiratory effort; 43 (22%) showed a simultaneous cessation of the cardiac oscillation and respiratory effort; and 4 (2%) showed diaphragmatic activity appearing after cessation of the cardiac oscillation (airway occlusion). Respiratory efforts never preceded the cessation of the cardiac oscillation. The findings suggest that diaphragmatic action is not needed to occlude the airway in mixed apneas. The simultaneous cessation of cardiac oscillations (airway occlusion) and onset of respiratory efforts may indicate that such effort contributes to closure or is induced by the same stimulus that closes the airway. We speculate that the mechanism for airway closure in mixed apneas is most likely a lack of upper airway tone, which normally occurs with the cessation of a central drive to breathe. 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Sudden death ; Gestational Age ; Heart Rate ; Humans ; Infant, Newborn ; Infant, Premature, Diseases - diagnosis ; Infant, Premature, Diseases - etiology ; Intensive care medicine ; Medical sciences ; Pulmonary Ventilation - physiology ; Sleep Apnea Syndromes - diagnosis ; Sleep Apnea Syndromes - etiology ; Time Factors</subject><ispartof>The Journal of pediatrics, 1998-10, Vol.133 (4), p.509-512</ispartof><rights>1998 Mosby, Inc.</rights><rights>1998 INIST-CNRS</rights><rights>Copyright Mosby-Year Book, Inc. 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We examine whether respiratory efforts are necessary for airway closure using a new method of detecting airway obstruction, based on the disappearance of an amplified cardiac pulse observed on the respiratory flow tracing. We analyzed 198 episodes of mixed apnea of various lengths (≥3 seconds) observed in 33 preterm infants (birth weight, 1.4 ± 0.1 kg [mean ± SEM]; study weight, 1.7 ± 0.1 kg; gestational age, 29 ± 1 weeks; postnatal age, 33 ± 4 days). The great majority of these episodes (88%) had a central, followed by an obstructive, component. Infants were studied by using a nosepiece and a flow-through system. Respiratory efforts (abdominal and chest movements) were recorded. Of the apneas, 20 were <5 seconds; 78, 5 to <10 seconds; 45, 10 to <15 seconds; 27, 15 to <20 seconds; and 28, ≥20 seconds. Of the 198 mixed apneas, 151 (76%) occurred in the absence of any respiratory effort; 43 (22%) showed a simultaneous cessation of the cardiac oscillation and respiratory effort; and 4 (2%) showed diaphragmatic activity appearing after cessation of the cardiac oscillation (airway occlusion). Respiratory efforts never preceded the cessation of the cardiac oscillation. The findings suggest that diaphragmatic action is not needed to occlude the airway in mixed apneas. The simultaneous cessation of cardiac oscillations (airway occlusion) and onset of respiratory efforts may indicate that such effort contributes to closure or is induced by the same stimulus that closes the airway. We speculate that the mechanism for airway closure in mixed apneas is most likely a lack of upper airway tone, which normally occurs with the cessation of a central drive to breathe. (J Pediatr 1998;133:509-12)</description><subject>Airway Obstruction - complications</subject><subject>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</subject><subject>Biological and medical sciences</subject><subject>Emergency and intensive care: neonates and children. Prematurity. Sudden death</subject><subject>Gestational Age</subject><subject>Heart Rate</subject><subject>Humans</subject><subject>Infant, Newborn</subject><subject>Infant, Premature, Diseases - diagnosis</subject><subject>Infant, Premature, Diseases - etiology</subject><subject>Intensive care medicine</subject><subject>Medical sciences</subject><subject>Pulmonary Ventilation - physiology</subject><subject>Sleep Apnea Syndromes - diagnosis</subject><subject>Sleep Apnea Syndromes - etiology</subject><subject>Time Factors</subject><issn>0022-3476</issn><issn>1097-6833</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>1998</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkE1rFTEUQIMo9bX6EwpBRHQx9WYymSRuSilVC4UuVFyGTOZGUmYyYzKjvn9v2vd4i25KFjdwz_06hJwyOGPA2o_fAOq64o1s32v1QQIIVclnZMNAy6pVnD8nmwPykhznfAcAugE4IkdaKtkqtSE_L0L6a7fUDVNeE9J-TSH-omP4hz21c0SbaYh0TrhgGsvX27jkT_Q604R5DskuU9pS9H5KC43oMGebtuevyAtvh4yv9_GE_Ph89f3ya3Vz--X68uKmcoKxpdLeacGVdqI86FiHPe8EtK1ttGIdtNx2DrTAruXeyoY1yuu-tnW5r4be8xPybtd3TtPvFfNixpAdDoONOK3ZFC8gtOYFfPMIvJvWFMtuhulGNqJu6gKJHeTSlHNCb-YUxnKPYWDurZsH6-ZeqdHKPFg3stSd7puv3Yj9oWqvueTf7vM2Ozv4ZKML-YCV0VIqVrDzHYbF2J-AyWQXMDrsQ0K3mH4KTyzyH490njU</recordid><startdate>19981001</startdate><enddate>19981001</enddate><creator>Idiong, Nnanake</creator><creator>Lemke, Robert P.</creator><creator>Lin, Yuh-Jyh</creator><creator>Kwiatkowski, Kim</creator><creator>Cates, Don B.</creator><creator>Rigatto, Henrique</creator><general>Mosby, Inc</general><general>Elsevier</general><general>Mosby-Year Book, Inc</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>U9A</scope><scope>7X8</scope></search><sort><creationdate>19981001</creationdate><title>Airway closure during mixed apneas in preterm infants: Is respiratory effort necessary?</title><author>Idiong, Nnanake ; Lemke, Robert P. ; Lin, Yuh-Jyh ; Kwiatkowski, Kim ; Cates, Don B. ; Rigatto, Henrique</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c511t-9fc95389c5c5c0b1bed3b5066a4981b063abc095eb63fa74148f9d2a283320df3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>1998</creationdate><topic>Airway Obstruction - complications</topic><topic>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</topic><topic>Biological and medical sciences</topic><topic>Emergency and intensive care: neonates and children. Prematurity. Sudden death</topic><topic>Gestational Age</topic><topic>Heart Rate</topic><topic>Humans</topic><topic>Infant, Newborn</topic><topic>Infant, Premature, Diseases - diagnosis</topic><topic>Infant, Premature, Diseases - etiology</topic><topic>Intensive care medicine</topic><topic>Medical sciences</topic><topic>Pulmonary Ventilation - physiology</topic><topic>Sleep Apnea Syndromes - diagnosis</topic><topic>Sleep Apnea Syndromes - etiology</topic><topic>Time Factors</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Idiong, Nnanake</creatorcontrib><creatorcontrib>Lemke, Robert P.</creatorcontrib><creatorcontrib>Lin, Yuh-Jyh</creatorcontrib><creatorcontrib>Kwiatkowski, Kim</creatorcontrib><creatorcontrib>Cates, Don B.</creatorcontrib><creatorcontrib>Rigatto, Henrique</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>The Journal of pediatrics</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Idiong, Nnanake</au><au>Lemke, Robert P.</au><au>Lin, Yuh-Jyh</au><au>Kwiatkowski, Kim</au><au>Cates, Don B.</au><au>Rigatto, Henrique</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Airway closure during mixed apneas in preterm infants: Is respiratory effort necessary?</atitle><jtitle>The Journal of pediatrics</jtitle><addtitle>J Pediatr</addtitle><date>1998-10-01</date><risdate>1998</risdate><volume>133</volume><issue>4</issue><spage>509</spage><epage>512</epage><pages>509-512</pages><issn>0022-3476</issn><eissn>1097-6833</eissn><coden>JOPDAB</coden><abstract>Airway closure during mixed apneas in preterm infants may be due to lack of tone in the upper airway followed by collapse and obstruction or diaphragmatic action inducing obstruction. We examine whether respiratory efforts are necessary for airway closure using a new method of detecting airway obstruction, based on the disappearance of an amplified cardiac pulse observed on the respiratory flow tracing. We analyzed 198 episodes of mixed apnea of various lengths (≥3 seconds) observed in 33 preterm infants (birth weight, 1.4 ± 0.1 kg [mean ± SEM]; study weight, 1.7 ± 0.1 kg; gestational age, 29 ± 1 weeks; postnatal age, 33 ± 4 days). The great majority of these episodes (88%) had a central, followed by an obstructive, component. Infants were studied by using a nosepiece and a flow-through system. Respiratory efforts (abdominal and chest movements) were recorded. Of the apneas, 20 were <5 seconds; 78, 5 to <10 seconds; 45, 10 to <15 seconds; 27, 15 to <20 seconds; and 28, ≥20 seconds. Of the 198 mixed apneas, 151 (76%) occurred in the absence of any respiratory effort; 43 (22%) showed a simultaneous cessation of the cardiac oscillation and respiratory effort; and 4 (2%) showed diaphragmatic activity appearing after cessation of the cardiac oscillation (airway occlusion). Respiratory efforts never preceded the cessation of the cardiac oscillation. The findings suggest that diaphragmatic action is not needed to occlude the airway in mixed apneas. The simultaneous cessation of cardiac oscillations (airway occlusion) and onset of respiratory efforts may indicate that such effort contributes to closure or is induced by the same stimulus that closes the airway. We speculate that the mechanism for airway closure in mixed apneas is most likely a lack of upper airway tone, which normally occurs with the cessation of a central drive to breathe. (J Pediatr 1998;133:509-12)</abstract><cop>New York, NY</cop><pub>Mosby, Inc</pub><pmid>9787688</pmid><doi>10.1016/S0022-3476(98)70058-7</doi><tpages>4</tpages></addata></record> |
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| subjects | Airway Obstruction - complications Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy Biological and medical sciences Emergency and intensive care: neonates and children. Prematurity. Sudden death Gestational Age Heart Rate Humans Infant, Newborn Infant, Premature, Diseases - diagnosis Infant, Premature, Diseases - etiology Intensive care medicine Medical sciences Pulmonary Ventilation - physiology Sleep Apnea Syndromes - diagnosis Sleep Apnea Syndromes - etiology Time Factors |
| title | Airway closure during mixed apneas in preterm infants: Is respiratory effort necessary? |
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