Increased Work of Breathing due to Tracheomalacia in Neonates

• DOI: 10.1513/annalsats.202002-162oc
• Publication Date: 2020-06-24T21:19:20Z
• Authors: Chamindu C. Gunat...; Nara S. Higano; Erik B. Hysinger; Deep B. Gandhi; Robert J. Fleck; Andrew D. Hahn; Sean B. Fain; Jason C. Woods; Alister J. Bates
• Keywords: Tracheomalacia; Work of breathing; Tracheobronchomalacia; Bronchopulmonary Dysplasia; Exhalation

Rationale: Dynamic collapse of the tracheal lumen (tracheomalacia) occurs frequently in premature neonates, particularly those with common comorbidities such as bronchopulmonary dysplasia. The increases effort necessary to breathe (work breathing [WOB]). However, quantifying increased WOB related tracheomalacia has previously not been possible. Therefore, it is also currently possible separate impact on patient symptoms from parenchymal abnormalities.Objectives: To measure increase due airway motion individual subjects and without different types respiratory support.Methods: Fourteen neonatal intensive care unit using invasive mechanical ventilation were recruited. In eight, was diagnosed via clinical bronchoscopy, six did have tracheomalacia. Self-gated three-dimensional ultrashort-echo-time magnetic resonance imaging (MRI) performed each subject clinically indicated support obtain cine images anatomy during cycle. component resistance within trachea then calculated computational fluid dynamics (CFD) simulations airflow basis subject's anatomy, motion, rates. A second CFD simulation for held static at its largest (i.e., most open) position determine collapse.Results: tracheal-resistive because by an average 337% ± 295% 24% 14% (P < 0.02). group, who treated continuous positive pressure (CPAP) a RAM cannula expended less energy compared room air or high-flow nasal cannula.Conclusions: Neonatal expenditure neonates normal airways, CPAP may be able attenuate work. Subjects expend more alone than nontracheomalacia patients resistive entire system, according reported values. provide objective treatment response children