Forced expiratory flows and volumes in intubated and paralyzed infants and children: normative data up to 5 years of age

• Published in: Journal of applied physiology (1985) Vol. 107; no. 1; pp. 105 - 111
• Main Authors: von Ungern-Sternberg, Britta S, Trachsel, Daniel, Erb, Thomas O, Hammer, Jurg
• Format: Journal Article
• Language: English
• Published: Bethesda, MD Am Physiological Soc 01.07.2009; American Physiological Society
• Subjects: Anesthesia; Biological and medical sciences; Body Height - physiology; Child, Preschool; Children & youth; Female; Forced Expiratory Flow Rates - physiology; Forced Expiratory Volume - physiology; Fundamental and applied biological sciences. Psychology; Humans; Infant; Infants; Intubation; Intubation, Intratracheal - methods; Male; Pediatrics; Prospective Studies; Reference Values; Respiratory Function Tests - methods; Respiratory system; Studies; Ulna - anatomy & histology; Ventilation; Ventilators; Human; cuffed endotracheal tubes; Vertebrata; Lung function; Mammalia; forced deflation; infant lung function testing; Infant; ulna length; Child; Age
• ISSN: 8750-7587; 1522-1601
• DOI: 10.1152/japplphysiol.91649.2008

1 Division of Anesthesia and 2 Division of Critical Care and Pulmonology, University Children's Hospital Basel, Basel, Switzerland Submitted 27 December 2008 ; accepted in final form 14 May 2009 Reference equations that express indexes obtained from forced expiratory maneuvers in relation to height and/or other independent variables are lacking for infants and children with artificial airways. The present study was performed to establish normative data of forced expiration by forced deflation in healthy intubated and paralyzed infants and children and to develop prediction equations in relation to height and to ulna length to enable pulmonary assessments in children whose height is difficult to measure. Measurements of forced and passive expiratory maneuvers after inflation to +40 cmH 2 O inspiratory pressure were prospectively obtained in 100 healthy anesthetized children from 0 to 5 yr of age. Linear regressions of log-transformed forced vital capacity (FVC) and maximum expiratory flow at 25% and 10% FVC (MEF 25 and MEF 10 , respectively) obtained by forced deflation (–40 cmH 2 O airway opening pressure) and of analogous indexes obtained by passive deflation were used to develop prediction equations from height or ulna length. FVC was significantly dependent on age and height or ulna length. Prediction equations for FVC using height or ulna length were as follows: ln(FVC in ml) = –5.6 + 2.8 x ln(height in cm) and ln(FVC in ml) = 0.46 + 2.5 x ln(ulna length in cm). Younger subjects had a significantly steeper slope for FVC vs. height than the older age group. Normal reference data for forced expiratory maneuvers in intubated infants and children up to 5 yr of age will enable improved assessment of pulmonary dysfunction in acutely or chronically ventilator-dependent children. Using ulna length instead of height should facilitate respiratory assessment in ventilated children with spinal or joint deformities. forced deflation; ulna length; infant lung function testing; cuffed endotracheal tubes Address for reprint requests and other correspondence: J. Hammer, Div. of Intensive Care and Pulmonology, Univ. Children's Hospital Basel, Römergasse 8, 4005 Basel, Switzerland (e-mail: juerg.hammer{at}unibas.ch )