RT Journal Article
SR Electronic
T1 CPAP titration in infants with severe airway obstruction
JF European Respiratory Journal
JO Eur Respir J
FD European Respiratory Society
SP P2049
VO 42
IS Suppl 57
A1 Sonia Khirani
A1 Adriana Ramirez
A1 Sabrina Aloui
A1 Nicolas Leboulanger
A1 Arnaud Picard
A1 Brigitte Fauroux
YR 2013
UL http://erj.ersjournals.com/content/42/Suppl_57/P2049.abstract
AB IntroductionNoninvasive continuous positive airway pressure (CPAP) is recognised as an effective treatment for severe airway obstruction in young children.ObjectivesThe aim of the study was to compare a clinical and a physiological setting of CPAP in infants with nocturnal alveolar hypoventilation due to severe upper airway obstruction (UAO) or bronchopulmonary dysplasia (BPD).MethodsWe retrospectively analysed the respiratory mechanics in infants who underwent a CPAP titration. CPAP set on clinical noninvasive parameters (Clinical CPAP) was compared to CPAP set on the normalisation or maximal reduction of the oesophageal (Poes) and transdiaphragmatic pressure (Pdi) swings (Physiological CPAP). Expiratory gastric pressure (Pgas) swing was measured.ResultsThe data of twelve infants, mean age 10 ± 8 months, with UAO (n=7) or BPD (n=5) were analysed. The mean Clinical CPAP (8 ± 2 cmH2O) was associated with a significant decrease in Poes and Pdi swings (Poes swing decreased from 31 ± 15 cmH2O during spontaneous breathing to 21 ± 10 cmH2O during CPAP, p<0.05). The mean Physiological CPAP level was 2 ± 2 cmH2O higher than the mean Clinical CPAP level and was associated with a significantly greater improvement in all indices of respiratory effort (Poes swing 11 ± 5 cm H2O, p<0.05 as compared to the Clinical CPAP). An expiratory abdominal activity was present during the Clinical CPAP and decreased during the Physiological CPAP.ConclusionA physiological setting of noninvasive CPAP, based on the recording of the Poes and Pgas, is superior to a clinical setting based on clinical noninvasive parameters. An expiratory abdominal activity was present during spontaneous breathing and decreased during the Physiological CPAP setting.