Spectral characteristics of airway opening and chest wall tidal flows in spontaneously breathing preterm infants

Abstract

We compared the harmonic content of tidal flows measured simultaneously at the mouth and chest wall in spontaneously breathing very low birth weight infants ( n = 16, 1,114 ± 230 g, gestation age: 28 ± 2 wk). Airway opening flows were measured via face mask-pneumotachograph (P-tach), whereas chest wall flows were derived from respiratory inductance plethysmography (RIP) excursions. Next, for each, we computed two spectral shape indexes: 1) harmonic distortion ( k d; k d,P-tachand k d,RIP, respectively) defines the extent to which flows deviated from a single sine wave, and 2) the exponent of the power law ( s; s P-tachand s RIP, respectively), describing the spectral energy vs. frequency. P-tach and RIP flow spectra exhibited similar power law functional forms consistently in all infants. Also, mouth [ s P-tach = 3.73 ± 0.23% (95% confidence interval), k d,P-tach = 38.8 ± 4.6%] and chest wall ( s RIP = 3.51 ± 0.30%, k d,RIP = 42.8 ± 4.8%) indexes were similar and highly correlated ( s RIP = 1.17 × s P-tach + 0.85; r 2 = 0.81; k d,RIP = 0.90 × k d,P-tach + 8.0; r 2 = 0.76). The corresponding time to peak tidal expiratory flow-to-expiratory time ratio (0.62 ± 0.08) was higher than reported in older infants. The obtained s and k d values are similar to those reported in older and/or larger chronic lung disease infants, yet appreciably lower than for 1-mo-old healthy infants of closer age and/or size; this indicated increased complexity of tidal flows in very low birth weight babies. Importantly, we found equivalent flow spectral data from mouth and chest wall tidal flows. The latter are desirable because they avoid face mask artificial effects, including leaks around it, they do not interfere with ventilatory support delivery, and they may facilitate longer measurements that are useful in control of breathing assessment.