Innovative development of the inspired sinewave device to measure lung functions and inhomogeneity for diagnosis and evaluations of early lung diseases

Surprisingly, lung disease is still one of the leading causes of deaths in the developed countries, including UK. According to the UK National Health Service (NHS), Chronic Obstructive Pulmonary Disease (COPD) is the fifth biggest killer disease in the UK, killing approximately 25,000 people a year. This prob-lem is even worse in developing countries such as Vietnam, India and China, where air pollution is a big problem and the disease awareness is under-recognised. The NHS has set out one of its challenges is to identify people with lung disease earlier in the disease’s development pathway, in order to pro-vide more effective and timely intervention and treatment. This paper presents a novel Inspired Sinewave Device (ISD) to measure lung function and inhomogeneity. Both set of infor-mation are important for diagnosis and detection of early lung diseases. ISD has the potential to replace or supplement the traditional spirometry in the routine lung function testing. The paper describes both the principle of ISD and a set of experi-mental results demonstrating the capability of ISD to asymp-totically detect asthmatic symptoms. Finally the paper discuss-es the future plan, including the testing of 300+ COPD patients at the Oxford Respiratory Trials Unit in UK, and the potential collaborations among research institutions in Vietnam and UK about cost-effective and innovative developments of smart devices, biosensors, lab-on-chips and telehealth solutions for the routine lung function testing, diagnosis and evaluations of early lung diseases

Relationship between physiologic deadspace/tidal volume ratio and gas exchange in infants with acute bronchiolitis on invasive mechanical ventilation

Objectives. To evaluate the association between deadspace/ tidal volume ratio (V-D/V-T) and gas exchange variables: PaO2, PacO(2), PaO2/FIO2, arterial/alveolar oxygen tension ratio (PaO2/PAO(2)), alveolar-arterial oxygen tension difference/arterial oxygen tension ratio (P(A-a)O-2/PaO2), carbon dioxide production (VCO2), ventilation index ([PaCO2 x peak inspiratory pressure x mechanical respiratory rate]/1000), and oxygenation index ([mean airway pressure x FIO2 x 100]/PaO2), all measured at an early stage in children with obstructive acute respiratory failure. Design: Prospective, cross-sectional, observational study. Setting: Pediatric intensive care unit, university hospital. Patients: Twenty-nine infants with acute bronchiolitis, defined according to clinical and radiologic criteria, Children with chronic pulmonary disease, neuromuscular disease, congenital cardiopathies, or hemodynamic instability were excluded. Interventions: Measurements were made between 24 and 72 hrs of mechanical ventilation using volumetric capnography and arterial blood gas analysis. Measurements and Main Results: The following variables significantly correlated with V-D/V-T, calculated using Spearman's correlation coefficient (r(s)): PaO2 (r(s) = -0.63, p < .001), PaO2/FIO2 (r(s) = -0.56, p = .002), PaO2/PAO(2) (r(s) = -0.46, p = .012), P(A-a)O-2/PaO2 (r(s) = 0.46, p =.012), PaCO2 (r(s) = 0.51, p = .005), VCO2 (r(s) = -0,62, p < .01), oxygenation index (r(s) = 0.48, p = .009), and ventilation index (r(s) = -0.53, p =.003). A statistically significant association was found between an increase in V-D/V-T and severity of lung injury, defined as PaO2/FIO2 < 200 (p =.03, Mann-Whitney). Conclusions: In the study population, V-D/V-T not only reflected ventilatory disorders, as is well recognized, but also was associated with disturbances of oxygenation. These results warrant further evaluation of the usefulness of serial measurement of V-D/V-T as a marker of disease severity in severe acute bronchiolitis and other causes of respiratory failure.8437237

Neonatal and Pediatric Manual Hyperinflation: Influence of Oxygen Flow on Ventilation Parameters

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)BACKGROUND: Although self-inflating bags are widely used for manual hyperinflation, they do not allow ventilation parameters, such as pressure or volume, to be set. We studied the ventilation performance of neonatal and pediatric self-inflating bags. METHODS: We asked 22 physiotherapists to manually hyperinflate 2 lung models (neonatal and pediatric), using self-inflating bags from 3 manufactures (Hudson, Laerdal, and JG Moriya), with flows of 0, 5, 10, and 15 L/min. A pneumotachograph recorded tidal volume (V-T), peak inspiratory pressure (PIP), peak inspiratory flow (PH), peak expiratory flow (PEF), and inspiratory time. RESULTS: The V-T, PIP, and inspiratory time delivered by the Hudson, Laerdal, and JG Moriya bags, in both neonatal and pediatric self-inflating bags, were significantly different (P < .001). The PEF and PIF delivered were different only when using the neonatal self-inflating bags (P < .001). The V-T, PIP, and PIF delivered with a flow of 0 L/min were lower than with 15 L/min (P < .05) with all the tested bags, in both the neonatal and pediatric sizes. CONCLUSIONS: The performance of the tested neonatal and pediatric bags varied by manufacturer and oxygen flow. There was an increase in V-T, PIP, and PIP related to the increase of oxygen flow from 0 L/min to 15 L/min. The neonatal bags showed higher ventilation parameters variation than the pediatric bags. (C) 2013 Daedalus Enterprises581221272133Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES

Innovative development of the inspired sinewave device to measure lung functions and inhomogeneity for diagnosis and evaluations of early lung diseases

Surprisingly, lung disease is still one of the leading causes of deaths in the developed countries, including UK. According to the UK National Health Service (NHS), Chronic Obstructive Pulmonary Disease (COPD) is the fifth biggest killer disease in the UK, killing approximately 25,000 people a year. This prob-lem is even worse in developing countries such as Vietnam, India and China, where air pollution is a big problem and the disease awareness is under-recognised. The NHS has set out one of its challenges is to identify people with lung disease earlier in the disease’s development pathway, in order to pro-vide more effective and timely intervention and treatment. This paper presents a novel Inspired Sinewave Device (ISD) to measure lung function and inhomogeneity. Both set of infor-mation are important for diagnosis and detection of early lung diseases. ISD has the potential to replace or supplement the traditional spirometry in the routine lung function testing. The paper describes both the principle of ISD and a set of experi-mental results demonstrating the capability of ISD to asymp-totically detect asthmatic symptoms. Finally the paper discuss-es the future plan, including the testing of 300+ COPD patients at the Oxford Respiratory Trials Unit in UK, and the potential collaborations among research institutions in Vietnam and UK about cost-effective and innovative developments of smart devices, biosensors, lab-on-chips and telehealth solutions for the routine lung function testing, diagnosis and evaluations of early lung diseases

Avaliação funcional pulmonar em crianças e adolescentes asmáticos: comparação entre a micro espirometria e a espirometria convencional Pulmonary function tests in asthmatic children and adolescents: Comparison between a microspirometer and a conventional spirometer

INTRODUÇÃO: A espirometria é muito utilizada no diagnóstico e na quantificação dos distúrbios ventilatórios como a asma. O micro espirômetro é um equipamento portátil e de fácil utilização que pode substituir o espirômetro convencional, embora existam poucas evidências de sua acurácia. OBJETIVO: Comparar o micro espirômetro com o espirômetro convencional em crianças e adolescentes asmáticos. MÉTODO: Os aparelhos utilizados foram o Micro Spirometer, da marca Micro Medical, e o espirômetro convencional Cosmed-Pony graphic 3.5, ambos com turbinômetros (sensores de fluxo). Foram incluídos na amostra 62 crianças e adolescentes, de ambos os sexos, com idades compreendidas entre cinco e dezesseis anos, com diagnóstico clínico de asma, em acompanhamento em serviço de Pneumologia. Os exames espirométricos foram realizados dentro das normas da American Thoracic Society e da Associação Brasileira de Normas Técnicas. Primeiro realizou-se a micro espirometria e em seguida, com o mesmo paciente, realizou-se a espirometria convencional. Os parâmetros analisados em ambos os aparelhos foram: capacidade vital forçada, volume expiratório forçado no primeiro segundo e pico de fluxo expiratório. Os dados foram analisados através do teste t de Student (pareado) e do teste de correlação de Pearson. RESULTADOS: Obteve-se forte correlação entre os parâmetros analisados nos dois aparelhos: para volume expiratório forçado no primeiro segundo r = 0,97, para capacidade vital forçada r = 0,97, e para pico de fluxo expiratório r = 0,91. CONCLUSÃO: Os resultados demonstraram que o micro espirômetro é um equipamento diagnóstico útil, que pode ser utilizado quando o espirômetro convencional não estiver disponível.<br>BACKGROUND: Spirometry is widely used in the diagnosis and quantification of respiratory disorders such as asthma. A microspirometer is a portable and easily used apparatus that can substitute for a regular spirometer, although there is little evidence of its accuracy. OBJECTIVE: Tocompare the microspirometer to a regular spirometer for use in asthmatic children and adolescents. METHODS: The instruments used were a Micro Spirometer, manufactured by Micro Medical, and a conventional Cosmed Pony Graphic 3.5 spirometer, both with turbinometers (flow sensors). The study sample consisted of 62 children and adolescents, of both genders, clinically diagnosed with asthma and under treatment at a pulmonology clinic. Ages ranged from 5 and 16 years. All spirometric tests were carried out according to the guidelines established by the American Thoracic Society and by the Associacão Brasileira de Normas Técnicas (Brazilian Technical Standards Association). For each patient, microspirometry was performed first, followed by conventional spirometry. The parameters analyzed in both devices were forced vital capacity, forced expiratory volume in one second and peak expiratory flow. Data were analyzed using the Student's t-test and Pearson's correlation test. RESULTS: Strong correlations were found between the two devices in the parameters analyzed: forced expiratory volume in one second: r = 0.97; forced vital capacity: r = 0.97; and peak expiratory flow: r = 0.91. CONCLUSION: These results demonstrate that the microspirometer is a useful diagnostic tool that can be used when a conventional spirometer is unavailable