Introduction:Impulse oscillometry(IOS)employs high frequency sinusoidal or impulse pressure and flow waveforms to interrogate the mechanical properties of the respiratory system.It has special applications to preschoo...Introduction:Impulse oscillometry(IOS)employs high frequency sinusoidal or impulse pressure and flow waveforms to interrogate the mechanical properties of the respiratory system.It has special applications to preschool and younger children who may have difficulty performing the repetitive forced expiratory maneuvers required for spirometry.Case presentation:We present a case illustrating improvements of respiratory system mechanics measured by IOS in a 6-year-old child with cystic fibrosis(CF)who demonstrated clinical and radiological improvement after a course of therapy with hospitalization and intravenous antibiotics,and initiation of a cystic fibrosis transmembrane regulator(CFTR)protein corrector/potentiator agent.We also report a new finding:observed lower than expected reactance at low compared to high frequencies("reactance inversion").Conclusion:Reactance inversion may reflect parallel pathway inhomogeneities in resistance and elastance or intrabreath airway inertance changes in young children with CF.Further study is needed in children with airway obstruction due to asthma,cystic fibrosis,and chronic lung disease of infancy to demonstrate the prevalence of this finding and whether it is specific to a measurement device.展开更多
Importance:Objective measures of lung function are critical for assessing respiratory outcomes of prematurity.Among extremely low gestational age neonates(ELGANs)(<29 weeks gestational age),high rates of neurodevel...Importance:Objective measures of lung function are critical for assessing respiratory outcomes of prematurity.Among extremely low gestational age neonates(ELGANs)(<29 weeks gestational age),high rates of neurodevelopmental impairment may interfere with lung function testing.Impulse oscillometry(IOS)is a noninvasive test of respiratory system mechanics not requiring forced expiration.Objective:To describe a multicenter study design for respiratory follow-up testing in a cohort with a high rate of extreme prematurity.Methods:School-age children enrolled in two prior trials of ELGANs and term controls were assessed by IOS at five centers.Groups consisted of children with prematurity with a high incidence of bronchopulmonary dysplasia,children with prematurity with no or minimal lung disease,and healthy term children.A rigorous centralized review process reviewed IOS studies for technical acceptability.Approach to design and implementation,rates of feasibility and success,and characteristics of participants are described.Results:A total of 243 children were recruited,of whom 239(98%)attempted oscillometry.There were high rates of technical acceptability across all three cohorts(85%–90%of attempted tests),and across all five centers(80%–94%of attempted tests).Respiratory and neuromotor clinical factors associated with testing failure included a higher number of days on ventilation during neonatal intensive care,a history of intraventricular hemorrhage grade 3 or 4,and gross motor functional impairment.Interpretation:We report high rates of feasibility and success of oscillometry in a large multicenter ELGAN population,in whom neurological and developmental comorbidities likely play a confounding role.展开更多
文摘Introduction:Impulse oscillometry(IOS)employs high frequency sinusoidal or impulse pressure and flow waveforms to interrogate the mechanical properties of the respiratory system.It has special applications to preschool and younger children who may have difficulty performing the repetitive forced expiratory maneuvers required for spirometry.Case presentation:We present a case illustrating improvements of respiratory system mechanics measured by IOS in a 6-year-old child with cystic fibrosis(CF)who demonstrated clinical and radiological improvement after a course of therapy with hospitalization and intravenous antibiotics,and initiation of a cystic fibrosis transmembrane regulator(CFTR)protein corrector/potentiator agent.We also report a new finding:observed lower than expected reactance at low compared to high frequencies("reactance inversion").Conclusion:Reactance inversion may reflect parallel pathway inhomogeneities in resistance and elastance or intrabreath airway inertance changes in young children with CF.Further study is needed in children with airway obstruction due to asthma,cystic fibrosis,and chronic lung disease of infancy to demonstrate the prevalence of this finding and whether it is specific to a measurement device.
基金National Heart,Lung,and Blood Institute,Grant/Award Numbers:U24HL137729,U24HL143216,UG3HL143204,UH3HL137872,UH3HL137872-04S1Eunice Kennedy Shriver National Institute of Child Health and Human Development,Grant/Award Numbers:UG1HD21373,UG1HD27853,UG1HD27856,UG1HD36790,UG1HD68244,UG1HD68284,UG1HD68244+2 种基金Children’s Hospital of Philadelphia,Grant/Award Number:Morse Asthma Research FundThe Capek FoundationNational Human Genome Research Institute,Grant/Award Number:T32 HG009495
文摘Importance:Objective measures of lung function are critical for assessing respiratory outcomes of prematurity.Among extremely low gestational age neonates(ELGANs)(<29 weeks gestational age),high rates of neurodevelopmental impairment may interfere with lung function testing.Impulse oscillometry(IOS)is a noninvasive test of respiratory system mechanics not requiring forced expiration.Objective:To describe a multicenter study design for respiratory follow-up testing in a cohort with a high rate of extreme prematurity.Methods:School-age children enrolled in two prior trials of ELGANs and term controls were assessed by IOS at five centers.Groups consisted of children with prematurity with a high incidence of bronchopulmonary dysplasia,children with prematurity with no or minimal lung disease,and healthy term children.A rigorous centralized review process reviewed IOS studies for technical acceptability.Approach to design and implementation,rates of feasibility and success,and characteristics of participants are described.Results:A total of 243 children were recruited,of whom 239(98%)attempted oscillometry.There were high rates of technical acceptability across all three cohorts(85%–90%of attempted tests),and across all five centers(80%–94%of attempted tests).Respiratory and neuromotor clinical factors associated with testing failure included a higher number of days on ventilation during neonatal intensive care,a history of intraventricular hemorrhage grade 3 or 4,and gross motor functional impairment.Interpretation:We report high rates of feasibility and success of oscillometry in a large multicenter ELGAN population,in whom neurological and developmental comorbidities likely play a confounding role.
