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Forced expiratory maneuvers from an increased lung volume in infants date from 1989 and consist of raising the inspiratory volume by applying a specific inflation pressure until a level close to the total lung capacity is reached. The chest and abdomen are then compressed by means of an inflatable jacket in order to obtain a forced expiratory flow–volume curve similar to that obtained for an adult. Forced expiration from an increased lung volume in infants is useful, just as the maneuver is in older patients, for studying airway function, diagnosing obstructive diseases early, and assessing response to treatment.
The objective of this review is to provide information on the physiological bases and technical aspects of a lung function test that has proven highly useful for the study of the airways of healthy infants as well as those with respiratory diseases.
Key words:
Infant lung function
Forced expiration
Raised lung volume
En el lactante, las maniobras de espiración forzada desde un volumen pulmonar aumentado datan de 1989 y consisten en aumentar el volumen inspiratorio mediante la aplicación de una presión de inflación determinada, hasta un nivel cercano a la capacidad pulmonar total, para posteriormente proceder a una compresión toracoabdominal mediante la aplicación de una chaqueta inflable, con el fin de obtener una curva espiratoria forzada semejante a la obtenida en el adulto. La espiración forzada desde volúmenes pulmonares aumentados en el lactante, al igual que en sujetos mayores, es útil para el estudio funcional de la vía aérea, pues permite diagnosticar precozmente enfermedades obstructivas y evaluar su respuesta al tratamiento.
El objetivo de la presente revisión es dar a conocer las bases fisiológicas y los aspectos técnicos de uno de los exámenes de función pulmonar de mayor utilidad en el estudio de la vía aérea del lactante sano y patológico.
Palabras clave:
Función pulmonar en lactantes
Espiración forzada
Volúmenes pulmonares aumentados
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References
[1]
R Tiffeneau, A Pinelli.
Air circulant et air captif dans l'exploration de la fonction ventilatrice pulmonaire.
Paris Med, 133 (1947), pp. 624-628
[2]
S Adler, ME Wohl.
Flow-volume relationship at low lung volumes in healthy term newborn infants.
Pediatrics, 61 (1978), pp. 636-640
[3]
LM Taussig, L Landau, S Godfrey, I Arad.
Determinants of forced expiratory flows in newborn infants.
J Appl Physiol, 53 (1982), pp. 1220-1227
[4]
RS Tepper, WJ Morgan, K Cota, A Wright, LM Taussig.
Physiologic growth and development of the lung during the first year of life.
Am Rev Respir Dis, 134 (1986), pp. 513-519
[5]
DJ Turner, SM Stick, KL LeSouëf, PD Sly, PN LeSouëf.
A new technique to generate and assess forced expiration from raised lung volume in infants.
Am J Respir Crit Care Med, 151 (1995), pp. 1441-1450
[6]
R Tepper, A Feher, A McLean.
Comparison of forced expiratory flows initiated at end-tidal inspiration and at elevated lung volumes in normal infants [abstract].
Am Rev Respir Dis, 147 (1993), pp. A222
[7]
R Castile, D Fibrun, R Flucke, N Shani, K McCoy.
Measurement of full flow-volume curves in sedated infants [abstract].
Am J Respir Crit Care Med, 149 (1994), pp. A37
[8]
DJ Turner, CJ Lanteri, PN leSouëf, PD Sly.
Pressure transmission across the respiratory system at raised lung volumes in infants.
J Appl Physiol, 77 (1994), pp. 1015-1020
[9]
DJ Turner, PD Sly, PN leSouëf.
Assessment of forced expiratory volume-time parameters in detecting histamine-induced bronchoconstriction in wheezy infants.
Pediatr Pulmonol, 15 (1993), pp. 220-224
[10]
A Feher, R Castile, J Kisling, C Angelicchio, D Filbrun, R Flucke, et al.
Flow limitation in normal infants: a new method for forced expiratory maneuvers from raised lung volumes.
J Appl Physiol, 80 (1996), pp. 2019-2025
[11]
PC Kosch, AR Stark.
Dynamic maintenance of end-expiratory lung volume in full-term infants.
J Appl Physiol, 57 (1984), pp. 1126-1133
[12]
PC Kosch, AA Hutchison, JA Wozniak, WA Carlo, AR Stark.
Posterior cricoarytenoid and diaphragm activities during tidal breathing in neonates.
J Appl Physiol, 64 (1988), pp. 1968-1978
[13]
JP Mortola, D Magnante, M Saetta.
Expiratory pattern of newborn mammals.
J Appl Physiol, 58 (1985), pp. 528-533
[14]
AR Stark, BA Cohlan, TB Waggener, ID Frantz, PC Kosch.
Regulation of end-expiratory lung volume during sleep in premature infants.
J Appl Physiol, 62 (1987), pp. 1117-1123
[15]
PN leSouëf, SJ England, AC Bryan.
Passive respiratory mechanics in newborn and children.
Am Rev Respir Dis, 129 (1984), pp. 552-556
[16]
J Stocks, PD Sly, RS Tepper, WJ Morgan.
Infant respiratory function testing, John Wiley & Sons, (1996),
[17]
U Frey, J Stocks, A Coates, P Sly, J Bates.
Specifications for equipment used for infant pulmonary function testing. ERS/ATS Task Force on Standards for Infant Respiratory Function Testing.
Eur Respir J, 16 (2000), pp. 731-740
[18]
U Frey, J Stocks, P Sly, J Bates.
Specifications for signal processing and data handling used for infant pulmonary function testing. ERS/ATS Task Force on Standards for Infant Respiratory Function Testing.
Eur Respir J, 16 (2000), pp. 1016-1022
[19]
ATS/ERS Workshop Summary.
The raised volume rapid thoracoabdominal compression technique.
Am J Respir Crit Care Med, 161 (2000), pp. 1760-1762
[20]
ATS/ERS Statement.
Raised volume forced expiration in infants. Guidelines for current practice.
Am J Respir Crit Care Med, 172 (2005), pp. 1463-1471
[21]
M Jones, R Castile, S Davis, J Kisling, D Filbrun, R Flucke, et al.
Forced expiratory flows and volumes in infants. Normative data and lung growth.
Am J Respir Crit Care Med, 161 (2000), pp. 353-359
[22]
PN leSouëf, DM Hughes, L Landau.
Effect of compression pressure on forced expiratory flow in infants.
J Appl Physiol, 61 (1986), pp. 1639-1646
[23]
J Mallol, M Hibbert, C Robertson, A Olinsky, PD Phelan, PD Sly.
Inherent variability of pulmonary function tests in infants with bronchiolitis.
Pediatr Pulmonol, 5 (1988), pp. 152-157
[24]
S Lum, AF Hoo, J Stocks.
Effect of airway inflation pressure on forced expiratory maneuvers from raised lung volume in infants.
Pediatr Pulmonol, 33 (2002), pp. 130-134
[25]
J Mallol, PD Sly.
Effect of chloral hydrate on arterial oxygen saturation in wheezy infants.
Pediatr Pulmonol, 5 (1988), pp. 96-99
[26]
C Gaultier, ME Fletcher, C Beardsmore, S England, E Motoyama.
Respiratory function measurements in infants: measurements conditions. Report of working group/ERS-ATS statement.
Eur Respir J, 8 (1995), pp. 1057-1066
[27]
PH Quanjer, PD Sly, J Stocks.
Respiratory function measurements in infants: symbols, abbreviations and units. Report of working group/ERS-ATS statement.
Eur Respir J, 8 (1995), pp. 1039-1056
[28]
J Mallol, VL Aguirre, G Wandalsen.
Variability of the raised volume rapid thoracic compression technique in infants with recurrent wheezing.
Allergol Immunopathol, 33 (2005), pp. 74-79
[29]
JH Wildhaber, ND Dore, SG Devadason, GL Hall, J Hamacher, L Arheden, et al.
Comparison of subjective and objective measures in recurrently wheezy infants.
Respiration, 69 (2002), pp. 397-405
[30]
MH Jones, J Howard, S Davis, J Kisling, RS Tepper.
Sensitivity of spirometric measurements to detect airway obstruction in infants.
Am J Respir Crit Care Med, 167 (2003), pp. 1283-1286
[31]
S Ranganathan, A Bush, C Dezateux, S Carr, A-F Hoo, S Lum, the London Collaborative Cystic Fibrosis Group, et al.
Relative ability of full and partial forced expiratory maneuvers to identify diminished airway function in infants with cystic fibrosis.
Am J Respir Crit Care Med, 166 (2002), pp. 1350-1357
[32]
S Davis, M Jones, J Kisling, J Howard, RS Tepper.
Comparison of normal infants and infants with cystic fibrosis using forced expiratory flows breathing air and heliox.
Pediatr Pulmonol, 31 (2001), pp. 1723
[33]
SC Ranganathan, A Bush, C Dezateux, et al.
Relative ability of full and partial forced expiratory maneuvers to identify diminished airway function in infants with cystic fibrosis.
Am J Respir Crit Care Med, 15 (2002), pp. 1350-1357
[34]
SC Ranganathan, I Goetz, AF Hoo, S Lum, R Castle, J Stocks, London Collaborative Cystic Fibrosis Group.
Assessment of tidal breathing parameters in infants with cystic fibrosis.
Eur Respir J, 22 (2003), pp. 761-766
[35]
RS Tepper, T Williams-Nkomo, T Martínez, J Kisling, C Coates, J Daggy.
Parental smoking and airway reactivity in healthy infants.
Am J Respir Crit Care Med, 171 (2005), pp. 78-82
[36]
G Wandalsen, V Aguirre, J Mallol.
Espirometria em lactentes com sibilancia recorrente.
Rev Bras Alerg Imunopatol, 26 (2003), pp. 41-52
[37]
J Saito, WT Harris, J Gelfond, TL Noah, MW Leigh, R Jonson, et al.
Physiologic, bronchoscopic, and bronchoalveolar lavage fluid findings in young children with recurrent wheeze and cough.
Pediatr Pulmonol, 41 (2006), pp. 709-719
[38]
MJ Hayden, SG Devadason, PD Sly, JH Wildhaber, PN LeSouëf.
Methacholine responsiveness using the raised volume forced expiration technique in infants.
Am J Respir Crit Care Med, 155 (1997), pp. 1670-1675
[39]
CS Beardsmore, C Page, M Silverman.
The response to beta-agonists in wheezy infants: three methods compared.
Respir Med, 98 (2004), pp. 1138-1145
[40]
M Modl, E Eber, E Weinhandl, W Gruber, M Zach.
Assessment of bronchodilator responsiveness in infants with bronchiolitis.
Am J Respir Crit Care Med, 161 (2000), pp. 763-768
[41]
J Mallol, V Aguirre, L Barrueto.
Efecto de los corticoides inhalados sobre la talla, cortisol y crecimiento pulmonar en lactantes con sibilancias recurrentes.
Rev Chil Pediatr, 75 (2004), pp. S79
[42]
RS Tepper, M Jones, S Davis, J Kisling, R Castile.
Rate constant for forced expiration decreases with lung growth during infancy.
Am J Respir Crit Care Med, 160 (1999), pp. 835-838
[43]
S Godfrey, E Bar-Yishay, A Avital, C Springer.
Commentaries. What is the role of tests of lung function in the management of infants with lung disease?.
Pediatr Pulmonol, 36 (2003), pp. 1-9
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