Pediatric Intensive Care Unit and Center of Home Mechanical Ventilation, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
Department of Pediatric Pulmonology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
Pediatr Pulmonol. 2022 Jul;57(7):1618-1624. doi: 10.1002/ppul.25923. Epub 2022 Apr 26.
Spirometry plays an important role in the assessment of possible respiratory failure in children with neuromuscular diseases (NMDs). However, obtaining reliable spirometry results is a major challenge. We studied the relation between oscillometry and spirometry results. Oscillometry is an easy, noninvasive method to measure respiratory resistance R and reactance X. We hypothesized an increased R and reduced X in patients with more reduced lung function.
In this prospective single-center study, we included all children with NMDs able to perform spirometry. We consecutively measured R and X at 5, 11, and 19 Hz and (forced) vital capacity, peak expiratory flow. Spearman correlation coefficients and positive and negative predictive values were calculated. Regression curves were estimated.
We included 148 patients, median age 13 years (interquartile range: 8-16). A negative correlation was found between R and spirometry outcomes (Spearman correlation coefficient [ρ]: -0.5 to -0.6, p < 0.001). A positive correlation was found between X (i.e., less negative outcomes) and spirometry outcomes (ρ: 0.4-0.6, p < 0.001). Highest correlation was found at lower frequencies. Regression analysis showed a nonlinear relation. Measurement of inspiratory and expiratory R and X did not provide added value. Positive predictive values of 80%-85% were found for z-scores of R measured at 5 Hz versus (F)VC ≤ 60%.
We found a nonlinear relation between oscillometry and spirometry results with increased R and reduced X in patients with more restrictive lung function decline. Given the difficulties with performing spirometry, oscillometry may be a promising substitute.
在评估神经肌肉疾病（NMD）患儿可能发生的呼吸衰竭时，肺量测定法起着重要作用。然而，获得可靠的肺量测定法结果是一个主要挑战。我们研究了呼吸震荡测定法和肺量测定法结果之间的关系。呼吸震荡测定法是一种简单、无创的方法，可测量呼吸阻力 R 和电抗 X。我们假设，在肺功能下降较多的患者中，R 增加而 X 降低。
在这项前瞻性单中心研究中，我们纳入了所有能够进行肺量测定法的 NMD 患儿。我们连续测量了 5、11 和 19 Hz 时的 R 和 X 以及（用力）肺活量、呼气峰流速。计算了 Spearman 相关系数和阳性及阴性预测值。估计了回归曲线。
我们纳入了 148 例患儿，中位年龄为 13 岁（四分位间距：8-16）。发现 R 与肺量测定法结果之间呈负相关（Spearman 相关系数 [ρ]：-0.5 至-0.6，p<0.001）。X（即，更负的结果）与肺量测定法结果之间呈正相关（ρ：0.4-0.6，p<0.001）。在较低频率下相关性最高。回归分析显示出非线性关系。吸气和呼气 R 和 X 的测量并未提供额外的价值。在 5 Hz 时测量的 R 的 z 分数与（F）VC≤60%时，发现 R 的阳性预测值为 80%-85%。
我们发现，在神经肌肉疾病患儿中，呼吸震荡测定法和肺量测定法结果之间存在非线性关系，表现为肺功能下降较严重的患者 R 增加而 X 降低。鉴于进行肺量测定法存在困难，呼吸震荡测定法可能是一种有前途的替代方法。
