Journal article
Neonates With Tracheomalacia Generate Auto-Positive End-Expiratory Pressure via Glottis Closure
Chest, Vol.160(6), pp.2168-2177
12/2021
DOI: 10.1016/j.chest.2021.06.021
PMCID: PMC8692107
PMID: 34157310
Abstract
In pediatrics, tracheomalacia is an airway condition that causes tracheal lumen collapse during breathing and may lead to the patient requiring respiratory support. Adult patients can narrow their glottis to self-generate positive end-expiratory pressure (PEEP) to raise the pressure in the trachea and prevent collapse. However, auto-PEEP has not been studied in newborns with tracheomalacia. The objective of this study was to measure the glottis cross-sectional area throughout the breathing cycle and to quantify total pressure difference through the glottis in patients with and without tracheomalacia.
Do neonates with tracheomalacia narrow their glottises? How does the glottis narrowing affect the total pressure along the airway?
Ultrashort echo time MRI was performed in 21 neonatal ICU patients (11 with tracheomalacia, 10 without tracheomalacia). MRI scans were reconstructed at four different phases of breathing. All patients were breathing room air or using noninvasive respiratory support at the time of MRI. Computational fluid dynamics simulations were performed on patient-specific virtual airway models with airway anatomic features and motion derived via MRI to quantify the total pressure difference through the glottis and trachea.
The mean glottis cross-sectional area at peak expiration in the patients with tracheomalacia was less than half that in patients without tracheomalacia (4.0 ± 1.1 mm2 vs 10.3 ± 4.4 mm2; P = .002). The mean total pressure difference through the glottis at peak expiration was more than 10 times higher in patients with tracheomalacia compared with patients without tracheomalacia (2.88 ± 2.29 cm H2O vs 0.26 ± 0.16 cm H2O; P = .005).
Neonates with tracheomalacia narrow their glottises, which raises pressure in the trachea during expiration, thereby acting as auto-PEEP.
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Details
- Title: Subtitle
- Neonates With Tracheomalacia Generate Auto-Positive End-Expiratory Pressure via Glottis Closure
- Creators
- Chamindu C Gunatilaka - Cincinnati Children's Hospital Medical CenterErik B Hysinger - Cincinnati Children's Hospital Medical CenterAndreas Schuh - Imperial College LondonDeep B Gandhi - Cincinnati Children's Hospital Medical CenterNara S Higano - Cincinnati Children's Hospital Medical CenterQiwei Xiao - Cincinnati Children's Hospital Medical CenterAndrew D Hahn - University of Wisconsin–MadisonSean B Fain - University of Wisconsin–MadisonRobert J Fleck - Cincinnati Children's Hospital Medical CenterJason C Woods - Cincinnati Children's Hospital Medical CenterAlister J Bates - Cincinnati Children's Hospital Medical Center
- Resource Type
- Journal article
- Publication Details
- Chest, Vol.160(6), pp.2168-2177
- Publisher
- Elsevier Inc
- DOI
- 10.1016/j.chest.2021.06.021
- PMID
- 34157310
- PMCID
- PMC8692107
- ISSN
- 0012-3692
- eISSN
- 1931-3543
- Grant note
- T32 HL007752 / NIH R01 HL146689 / NIH K99 HL144822 / National Institutes of Health (https://doi.org/10.13039/100000002)
- Language
- English
- Date published
- 12/2021
- Academic Unit
- Roy J. Carver Department of Biomedical Engineering; Radiology; Electrical and Computer Engineering; Health and Human Physiology
- Record Identifier
- 9984274956502771
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