Am. J. Respir. Crit. Care Med., Volume 164, Number 10, November 2001, 1874-1878

Chronic Stridor Caused by Laryngomalacia in Children
Work of Breathing and Effects of Noninvasive Ventilatory Assistance

BRIGITTE FAUROUX, JÉRÔME PIGEOT, MICHAEL I. POLKEY, GILLES ROGER, MICHÈLE BOULÉ, ANNICK CLÉMENT, and FRÉDÉRIC LOFASO

Pediatric Pulmonary Department and Otorhinolaryngology Department, Armand Trousseau Hospital, Assistance Publique, Hôpitaux de Paris, Paris, France; Physiology Department, Raymond Poincare Hospital, Assistance Publique, Hôpitaux de Paris, Garches; INSERM U492, Henri Mondor Faculty, Créteil, France; Respiratory Muscle Laboratory, Royal Brompton Hospital, London, United Kingdom

Breathing pattern, gas exchange, and respiratory effort were assessed in five awake children with chronic stridor caused by laryngomalacia during spontaneous breathing (SB) and noninvasive mechanical ventilation (NIMV). During SB, the youngest children were able to maintain normal gas exchange at the expense of an increased work of breathing as assessed by calculated diaphragmatic pressure-time product (PTPdi), whereas the opposite was observed in the older children. NIMV increased tidal volume, from 8.77 ± 2.04 ml/kg during SB to 11.67 ± 2.52 ml/kg during NIMV, p = 0.04, and decreased respiratory rate, from 24.4 ± 5.6 breaths/ min during SB to 16.6 ± 0.9 breaths/min during NIMV, p = 0.04. NIMV unloaded the respiratory muscles as reflected by the significant reduction in PTPdi, from a mean value of 541.0 ± 196.6 cm H₂O · s · min¹ during SB to 214.8 ± 116.0 cm H₂O · s · min¹ during NIMV, p = 0.04. Therefore, NIMV successfully relieves the additional load imposed on the respiratory muscles. Long-term home NIMV was provided to a total of 12 children with laryngomalacia (including these five) and was associated with clinical improvement in sleep and growth.

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