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Am. J. Respir. Crit. Care Med., Volume 161, Number 3, March 2000, 713-717

Flow Limitation in Infants Assessed by Negative Expiratory Pressure

MARCUS H. JONES, STEPHANIE D. DAVIS, JEFFREY A. KISLING, JOHN M. HOWARD, ROBERT CASTILE, and ROBERT S. TEPPER

Riley Children's Hospital, Indianapolis, Indiana; and Columbus Children's Hospital, Columbus, Ohio

Forced expiratory flows by the rapid compression technique are often used to assess airway function in infants; however, it remains unclear as to whether flow limitation (FL) is achieved. Studies in adults have used negative expiratory pressure (NEP) at the airway opening as a noninvasive technique to assess whether FL is achieved. An increase in flow with NEP indicates that FL has not been achieved, whereas no increase in flow with NEP indicates FL has been achieved. In the adult studies, the change in flow was assessed by visual inspection of the flow-volume curve. We evaluated whether NEP could be used to assess FL during forced expiration in infants. In addition, we quantified the change in flow secondary to NEP. We applied -5 cm H2O NEP to four infants during forced expiratory maneuvers. The step increase in flow with NEP was always less than 5% at high jacket compression pressures and consistent with FL. For one subject, FL was also confirmed from isovolume pressure flow-curves measured with an esophageal catheter. We conclude that NEP can be used in infants to assess FL during forced expiratory maneuvers by the rapid compression technique. Jones MH, Davis SD, Kisling JA, Howard JM, Castile R, Tepper RS. Flow limitation in infants assessed by negative expiratory pressure.




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