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Acquired Tracheomegaly in Very Preterm Neonates

Acquired Tracheomegaly in Very Preterm Neonates Abstract • Proximal airways are compliant structures at early gestational ages and may be susceptible to pressure-induced deformation following prolonged ventilatory support. Sixteen neonates (mean ± SD gestational age, 27.0 ±0.6 weeks; mean ± SD birth weight, 847 ±68 g) were studied to assess tracheal volume deformation. The neonates received ventilatory support for a mean ± SD duration of 25.4±4.9 days. During this period the maximum peak inspiratory pressures ranged from 15 to 25 cm H2O, and respirations ranged from 20/min to 60/min. These neonates were studied at seven days postextubation and were individually matched for body weight with 16 nonventilated neonates. The width of the tracheal air column was measured at the lower border of the first thoracic (T-1) and third thoracic (T-3) vertebrae. The average tracheal width (average of T-1 and T-3) was significantly (38%) wider in the ventilated group, and the mean ± SD tracheal width values were 3.79±0.29 mm, as compared with the control values of 2.74±0.31 mm. Based on these data It was estimated that the tracheal volume was 91% greater in the ventilated group. These observations demonstrate tracheal volume deformation and acquired tracheomegaly in neonates who have received mechanical ventilatory support. In addition to increased dead space ventilation, these findings also indicate underlying mechanical deformation of the tracheal wall. (AJDC 1986;140:449-452) References 1. Croteau JR, Cook CD: Volume-pressure and length-tension measurements in human tracheal and bronchial segments . J Appl Physiol 1961;16: 170-172. 2. Burnard ED, Grattan-Smith P, Picton-Marlow CG, et al: Pulmonary insufficiency in prematurity . Aust Paediatr J 1965;1:12-38. 3. Bhutani VK, Rubenstein SD, Shaffer TH: Pressure-volume relationships of trachea in fetal neonatal and adult rabbits . Respir Physiol 1981; 43:221-231.Crossref 4. Stocks J, Godfrey S: Specific airway conductance in relation to post-conceptual age during infancy . J Appl Physiol 1977;43:144-154. 5. Northway WH, Rosan RC, Porter DY: Pulmonary disease following respirator therapy of hyaline membrane disease: Bronchopulmonary dysplasia . N Engl J Med 1967;276:357-368.Crossref 6. Bhutani VK, Rubenstein SD, Shaffer TH: Pressure-induced deformation in immature airways . Pediatr Res 1981;15:829-832. 7. Snyder SM, Shaffer TH, Bhutani VK: Tracheal volume deformation in a developmental rabbit model . Biol Neonate 1984;46:192-197.Crossref 8. Bhutani VK, Shaffer TH: Time-dependent tracheal deformation in fetal, neonatal, and adult rabbits . Pediatr Res 1982;16:830-833.Crossref 9. Widdicombe JR: Regulation of tracheobronchial smooth muscle . Physiol Rev 1963;43:1-29. 10. Bader H: Dependence on wall stress in the human thoracic aorta on age and pressure . Circ Res 1967;20:354.Crossref 11. Dobrin PR: Mechanical properties of arteries . Physiol Rev 1978;58:397-460. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png American Journal of Diseases of Children American Medical Association

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Publisher
American Medical Association
Copyright
Copyright © 1986 American Medical Association. All Rights Reserved.
ISSN
0002-922X
DOI
10.1001/archpedi.1986.02140190059026
Publisher site
See Article on Publisher Site

Abstract

Abstract • Proximal airways are compliant structures at early gestational ages and may be susceptible to pressure-induced deformation following prolonged ventilatory support. Sixteen neonates (mean ± SD gestational age, 27.0 ±0.6 weeks; mean ± SD birth weight, 847 ±68 g) were studied to assess tracheal volume deformation. The neonates received ventilatory support for a mean ± SD duration of 25.4±4.9 days. During this period the maximum peak inspiratory pressures ranged from 15 to 25 cm H2O, and respirations ranged from 20/min to 60/min. These neonates were studied at seven days postextubation and were individually matched for body weight with 16 nonventilated neonates. The width of the tracheal air column was measured at the lower border of the first thoracic (T-1) and third thoracic (T-3) vertebrae. The average tracheal width (average of T-1 and T-3) was significantly (38%) wider in the ventilated group, and the mean ± SD tracheal width values were 3.79±0.29 mm, as compared with the control values of 2.74±0.31 mm. Based on these data It was estimated that the tracheal volume was 91% greater in the ventilated group. These observations demonstrate tracheal volume deformation and acquired tracheomegaly in neonates who have received mechanical ventilatory support. In addition to increased dead space ventilation, these findings also indicate underlying mechanical deformation of the tracheal wall. (AJDC 1986;140:449-452) References 1. Croteau JR, Cook CD: Volume-pressure and length-tension measurements in human tracheal and bronchial segments . J Appl Physiol 1961;16: 170-172. 2. Burnard ED, Grattan-Smith P, Picton-Marlow CG, et al: Pulmonary insufficiency in prematurity . Aust Paediatr J 1965;1:12-38. 3. Bhutani VK, Rubenstein SD, Shaffer TH: Pressure-volume relationships of trachea in fetal neonatal and adult rabbits . Respir Physiol 1981; 43:221-231.Crossref 4. Stocks J, Godfrey S: Specific airway conductance in relation to post-conceptual age during infancy . J Appl Physiol 1977;43:144-154. 5. Northway WH, Rosan RC, Porter DY: Pulmonary disease following respirator therapy of hyaline membrane disease: Bronchopulmonary dysplasia . N Engl J Med 1967;276:357-368.Crossref 6. Bhutani VK, Rubenstein SD, Shaffer TH: Pressure-induced deformation in immature airways . Pediatr Res 1981;15:829-832. 7. Snyder SM, Shaffer TH, Bhutani VK: Tracheal volume deformation in a developmental rabbit model . Biol Neonate 1984;46:192-197.Crossref 8. Bhutani VK, Shaffer TH: Time-dependent tracheal deformation in fetal, neonatal, and adult rabbits . Pediatr Res 1982;16:830-833.Crossref 9. Widdicombe JR: Regulation of tracheobronchial smooth muscle . Physiol Rev 1963;43:1-29. 10. Bader H: Dependence on wall stress in the human thoracic aorta on age and pressure . Circ Res 1967;20:354.Crossref 11. Dobrin PR: Mechanical properties of arteries . Physiol Rev 1978;58:397-460.

Journal

American Journal of Diseases of ChildrenAmerican Medical Association

Published: May 1, 1986

References