Published ahead of print on August 6, 2003, doi:10.1164/rccm.200303-460OC
Am. J. Respir. Crit. Care Med., Volume 168, Number 8, October 2003, 1003-1009
A more recent version of this article appeared on October 15, 2003
Submitted on April 1, 2003
Accepted on August 4, 2003
Progressive Decline in Plethysmographic Lung Volumes in Infants: Physiology or Technology?
Georg Hulskamp1*, Ah-fong Hoo2, Henrik Ljungberg3, Sooky Lum2, J Jane Pillow4, and Janet Stocks3
1 Portex Anaesthesia, Intensive Therapy and Respiratory Medicine Unit, Institute of Child Health and Great Ormond Street Hospital for Children NHS Trust, London, United Kingdom; Neonatal Unit, Homerton University Hospital, London, United Kingdom; Pediatrics, University of Munster, Munster, Germany,
2 Portex Anaesthesia, Intensive Therapy and Respiratory Medicine Unit, Institute of Child Health and Great Ormond Street Hospital for Children NHS Trust, London, United Kingdom; Neonatal Unit, Homerton University Hospital, London, United Kingdom,
3 Portex Anaesthesia, Intensive Therapy and Respiratory Medicine Unit, Institute of Child Health and Great Ormond Street Hospital for Children NHS Trust, London, United Kingdom,
4 Portex Anaesthesia, Intensive Therapy and Respiratory Medicine Unit, Institute of Child Health and Great Ormond Street Hospital for Children NHS Trust, London, United Kingdom; Neonatal Unit, Homerton University Hospital, London, United Kingdom; Neonatal Unit, University College London Hospitals, London, United Kingdom
* To whom correspondence should be addressed. E-mail: g.hulskamp{at}ich.ucl.ac.uk.
During the last 30 years there has been an unexplained trend towards declining values for plethysmographic assessments of lung volume at functional residual capacity in infants. The aim of this study was to compare data collected from healthy infants using contemporary equipment with published reference data and to explore reasons for discrepancies. Lung volumes were measured in 32 healthy infants (aged 4-93 weeks, weight 3.9-12.4 kg) using a new, commercially available infant plethysmograph. Mean (standard deviation) functional residual capacity was 19.6 (3.4) mLkg-1 [within subject coefficient of variation 3.4 (2.3) %], which was on average 7.0 (3.5) mLkg-1 and 2.3 (1.2) standard deviation (Z) scores lower than the recently collated reference data from an American Thoracic Society task force. Sixty six % of these healthy infants had a functional residual capacity below the predicted normal range. Comparison of equipment, software and protocols with those from previous reports revealed the importance for minimization of deadspace and adequate subtraction of all compressible occluded volume, when calculating functional residual capacity in infants. These findings emphasize the need to establish reference data for lung function tests in infants that are appropriate for the equipment and protocols in current use.
Key words: Functional residual capacity, plethysmography, infant, respiratory function tests
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