End‐expiratory lung volume remains stable during N2 MBW in healthy sleeping infants. Issue 16 (26th August 2020)

• Record Type: Journal Article
• Authors: Gustafsson, Per M.; Kadar, Laszlo; Kjellberg, Sanna; Andersson, Lena; Lindblad, Anders; Robinson, Paul D.
• Is Part Of: Physiological reports. Volume 8:Issue 16(2020)
• Page Start: n/a
• Page End: n/a
• Publication Date: 2020-08-26
• Subjects: breathing pattern -- functional residual capacity -- inert gas washout -- respiratory inductance plethysmography -- ultrasonic flow sensor; Physiology -- Periodicals; 571
• DOI: 10.14814/phy2.14477
• Languages: English
• ISSNs: 2051-817X

Abstract

Abstract: We have previously shown that functional residual capacity (FRC) and lung clearance index were significantly greater in sleeping healthy infants when measured by N2 (nitrogen) washout using 100% O2 (oxygen) versus 4% SF6 (sulfur hexafluoride) washout using air. Following 100% O2 exposure, tidal volumes decreased by over 30%, while end‐expiratory lung volume (EELV, i.e., FRC) rose markedly based on ultrasonic flow meter assessments. In the present study to investigate the mechanism behind the observed changes, N2 MBW was performed in 10 separate healthy full‐term spontaneously sleeping infants, mean (range) 26 (18–31) weeks, with simultaneous EELV monitoring (respiratory inductance plethysmography, RIP) and oxygen uptake (V´O2 ) assessment during prephase air breathing, during N2 washout by exposure to 100% O2, and subsequently during air breathing. While flow meter signals suggested a rise in ELLV by mean ( SD ) 26 (9) ml over the washout period, RIP signals demonstrated no EELV change. V'O2 /FRC ratio during air breathing was mean ( SD ) 0.43 (0.08)/min, approximately seven times higher than that calculated from adult data. We propose that our previously reported flow meter‐based overestimation of EELV was in fact a physiological artifact caused by rapid and marked movement of O2 across the alveolar capillary membrane into the blood and tissue during 100% O2 exposure, without concomitant transfer of N2 to the same degree in the opposite direction. This may be driven by the high observed O2 consumption and resulting cardiac output encountered in infancy. Furthermore, the low resting lung volume in infancy may make this error in lung volume determination by N2 washout relatively large. Abstract : In infancy, 100% O2 exposure during MBW decreased tidal volumes by >30%, whilst end‐expiratory lung volume (EELV, i.e., FRC) rose markedly, based on ultrasonic flow meter assessments. Respiratory inductance plethysmography signals demonstrated no EELV change. We propose this flow meter EELV overestimation is a physiological artifact caused by rapid marked O2 movement across the alveolar capillary membrane into blood and tissue during 100% O2 exposure, without concomitant equivalent N2 transfer in opposite direction. High O2 consumption and cardiac output in infancy may drive this. Low resting lung volume in infancy may make this lung volume determination error by N2 MBW relatively large.