Conclusion

The majority of techniques and tests described in this Section of the Statement are not presently in routine clinical use and many should be considered experimental. The tests can be put into one of three groups based on their feasibility in different settings.

1. Tests that are well established and validated for routine clinical use include Pi,max, PE,max and the direct visualization of upper airway structures.

2. Many tests are fairly well developed but still require validation and establishment of normal values. These tests are available for use in clinical investigations where there are specifically trained personnel and specialized equipment. They include measurements of Pmo,0.1, inspiratory pressure reserve and PTI, thoracoabdominal asynchrony, EMG of the respiratory and upper airway muscles, and critical and closing pressures of the upper airway.

3. Tests that are still under development and that are recommended for use only in research settings include measurement of Ccw, crying pressures, ultrasonography of the diaphragm, and phrenic nerve stimulation. These tests all require further investigation before their feasibility in clinical practice can be established.

References

1. Curzi-Dascalova L, Peirano P, Morel-Kahn F. Development of sleep states in normal premature and full-term newborns. Dev Psychobiol 1988;2:431-444.

2. Openshaw P, Edwards S, Helms P. Changes in rib cage geometry dur ing childhood. Thorax 1984;39:624-627.

3. Hershenson M, Colin A, Wohl M, Stark A. Change in the contribution of the rib cage to total breathing during infancy. Am Rev Respir Dis 1990;141:922-925.

4. Devlieger H, Daniel H, Marchal G, Moerman P, Casaer P, Eggermont

E. The diaphragm of the newborn infant: anatomical and ultrasonographic studies. J Dev Physiol 1991;16:321-329.

5. Tabachnik E, Muller N, Bryan A, Levison H. Changes in ventilation and chest wall mechanics during sleep in normal adolescents. J Appl Physiol 1981;51:557-564.

6. Agostoni E. Volume-pressure relationships to the thorax and lung in the newborn. J Appl Physiol 1959;14:909-913.

7. Kosch P, Stark A. Dynamic maintenance of end-expiratory lung vol ume in full-term infants. J Appl Physiol 1984;57:1126-1133.

8. Kosch P, Hutchison A, Wozniak J, Carlo W, Stark A. Posterior cri-

coarytenoid and diaphragm activities during tidal breathing in neo-nates. J Appl Physiol 1988;664:1968-1978.

9. Harding R, Jonhson P, McClelland M. Respiratory function of the lar ynx in developing sheep and the influence of sheep state. Respir Physiol 1980;40:165-170.

10. Colin A, Wolh M, Mead J, Patken J, Glass G, Stark A. Transition from dynamically maintained to relaxed end-expiratory volume in human infants. J Appl Physiol 1989;67:2107-2111.

11. Sieck G, Fournier M. Developmental aspects of diaphragm muscle cell, structural and functional organization. In: Haddad G, Farber J, editors. Developmental neurobiology of breathing. New York: Marcel Dekker; 1991. p. 375-428.

12. Cook C, Mead J, Ozales M. Static volume-pressures characteristics of the respiratory system during maximum effort. J Appl Physiol 1964; 19:1016-1022.

13. Gaultier C, Zinman R. Maximal static pressures in healthy children.

Respir Physiol 1983;51:45-61.

14. Shardonofsky F, Perez-chada D, Carmuega E, Milic-Emili J. Airway pressure during crying in healthy infants. Pediatr Pulmonol 1989;6:14-18.

15. Gaultier C, Perret L, Boule M, Buvry A, Girard F. Occlusion pressure and breathing pattern in healthy children. Respir Physiol 1981;46:71-80.

16. Gaultier C, Boule M, Tournier G, Girard F. Inspiratory force reserve of the respiratory muscles in children with chronic obstructive pulmonary disease. Am Rev Respir Dis 1985;131:811-815.

17. Milic-Emili J. Respiratory muscle fatigue and its implication in respira tory distress syndrome. In: Cosmi E, Scaepelli E, editors. Pulmonary surfactant system. Rome, Italy: Elsevier Science; 1983. p. 135-141.

18. Lesouef P, England S, Stogryn H, Brayn A. Comparison of diaphragmatic fatigue in newborn and older rabbits. J Appl Physiol 1988;65:1040-1044.

19. Sieck G, Fournier M, Blanco C. Diaphragm muscle fatigue resistance during postnatal development. J Appl Physiol 1991;71:458-464.

20. Curzi-Dascalova L. Thoraco-abdominal respiratory correlations in in fants: constancy and variability in different sleep states. Early Hum Dev 1978;2:25-38.

21. Gaultier C, Praud J, Canet E, Delapeche M, D'allest A. Paradoxical in ward rib cage motion during rapid eye movement sleep in infants and young children. J Dev Physiol 1987;9:391-397.

22. Guslits B, Gaston S, Bryan M, England S, Bryan A. Diaphragmatic work of breathing in premature human infants. J Appl Physiol 1987;62:1410-1415.

23. Roberts J, Reed W, Mathew O, Menon A, Thach B. Assessment of pharyngeal airway stability in normal and micrognathic infants. J Appl Physiol 1985;58:290-299.

24. Marcus C, McColley S, Carroll J, Loughlin G, Smith P. Upper airway collapsibility in children with obstructive sleep apnea syndrome. J Appl Physiol 1994;77:918-924.

25. Gleadhill I, Schwartz A, Schubert N, Wise R, Permutt S, Smith P. Up per airway collapsibility in snorers and in patients with obstructive hypopnea and apnea. Am Rev Respir Dis 1991;143:1300-1303.

26. American Thoracic Society/European Respiratory Society. Respira tory muscle function in infants: measurement conditions. Am J Respir Crit Care Med 1995;151:2058-2064.

27. Gaultier C, Fletcher M, Beardsmore C, England S, Motoyama E. Re spiratory function measurements in infants: measurement conditions. Eur Respir J 1995;8:1057-1066.

28. Sly P, Davis G. Equipment requirements for infant respiratory function testing. In: Stocks J, Sly P, Tepper R, Morgan W, editors. Infant respiratory function testing. New York: Wiley-Liss; 1996. p. 45-80.

29. Beardsmore C, Helms P, Stocks J, Hatch D, Silverman M. Improved esophageal balloon technique for use in infants. J Appl Physiol 1980; 49:735-742.

30. Lesouef P, Lopes J, England S, Bryan H, Bryan A. Influence of chest wall distortion on esophageal pressure. J Appl Physiol 1983;55:353.

31. Adams J. Respiratory inductive plethysmography. In: Stocks J, Sly P,

Tepper R, Morgan W, editors. Infant respiratory function testing. New York: Wiley-Liss; 1996. p. 139-164.

32. Gerhardt T, Bancalari E. Chest wall compliance in full term and pre mature infants. Acta Pediatr Scand 1980;69:359-364.

33. Papastamelos C, Panitch H, England S, Allen J. Developmental changes in chest wall compliance during infancy and early childhood. J Appl Physiol 1995;78:179-184.

34. Davis G, Coates A, Papageorgiou A, Bureau M. Direct measurement of static chest wall compliance in animal and human neonates. J Appl Physiol 1988;65:1093-1098.

35. Reynolds R, Etsten B. Mechanics of respiration in apneic anesthetized infants. Anesthesiology 1966;27:13-19.

36. Richard C, Bachman L. Lung and chest wall compliance in apneic para lyzed infants. J Clin Invest 1961;40:273-278.

37. Sharp J, Druz W, Balagot R, Bandelin V, Danon J. Total respiratory compliance in infants and children. J Appl Physiol 1970;29:775-779.

38. Mittman C, Edelman N, Norris A, Shock N. Relationship between chest wall and pulmonary compliance and age. J Appl Physiol 1965; 20:1211-1216.

39. Papastamelos C, Panitch H, Allen J. Chest wall compliance in infants 67.

and children with neuromuscular disease. Am J Respir Crit Care Med 1996;154:1045-1048. 68.

40. Estenne M, Heilporn A, Delhez L, Yelnault J, De Troyer A. Chest wall stiffness in patients with chronic respiratory muscle weakness. Am 69.

Rev Respir Dis 1983;128:1002-1007.

41. Szeinberg A, Marcotte J, Roizin H, Mindotff C, England S, Tabachnik 70.

E, Levison H. Normal values of maximal inspiratory and expiratory pressures with a portable apparatus in children, adolescents, and 71.

young adults. Pediatr Pulmonol 1987;3:255-258.

42. Smyth R, Chapman K, Rebunk A. Maximal inspiratory and expiratory pressures in adolescents: normal values. Chest 1984;86:568-572.

43. Wagener J, Hibbert M, Landau L. Maximal respiratory pressures in 72.

children. Am Rev Respir Dis 1984;129:873-875.

44. Wen A, Woo M, Keens T. How many attempts are required to accu rately measure maximal inspiratory pressures? Am J Respir Crit 73.

Care Med 1996;153:A559.

45. Zinman R, Gaultier C. Abdominothoracic configuration and maximal 74.

static pressures in children. Respir Physiol 1984;55:39-46.

46. Leech J, Ghezzo H, Stevens D, Becklale M. Respiratory pressures and function in young adults. Am Rev Respir Dis 1983;128:17-23. 75.

47. Wilson S, Cooke N, Edwards R, Spiro S. Predicted normal values for maximal respiratory pressures in Caucasian adults and children. Thorax 1984;39:535-538. 76.

48. Begin R, Bureau M, Lupien L, Lemieux B. Control and modulation of respiration in Steinert's myotonic dystrophy. Am Rev Respir Dis 1980; 121:281-289. 77.

49. Inkley S, Oldenburg F, Vignos P. Pulmonary function in Duchenne muscular dystrophy related to stage of disease. Am J Med 1974;56: 78. 297-306.

50. Lands L, Zinman R. Maximal static pressure and lung volumes in a 79.

child with Guillain-Barre syndrome ventilated by a cuirass respirator. Chest 1986;89:757-760.

51. Bureau M, Lupien L, Begin R. Neural drive and ventilatory strategy of breathing in normal children, and patients with cystic fibrosis and 80.

asthma. Pediatrics 1981;68:187-194.

52. Szeinberg A, England S, Mindorff C, Fraser I, Levison H. Maximal in-

spiratory and expiratory pressures are reduced in hyperinflated, mal- 81.

nourished young adult male patients with cystic fibrosis. Am Rev Respir Dis 1985;32:766-769.

53. Lands L, Desmond K, Demizio D, Pavilanis A, Coates A. The effects of 82.

nutritional status and hyperinflation on respiratory muscle strength in children and young adults. Am Rev Respir Dis 1990;141:1506-1509. 83.

54. Lands L, Heigenhauser G, Jones N. Respiratory and peripheral muscle function in cystic fibrosis. Am Rev Respir Dis 1993;147:865-869. 84.

55. Hayot M, Guillaumont S, Ramonatxom M, Voisin M, Prefaut C. Deter minants of the tension-time index of respiratory muscles in children with cystic fibrosis. Pediatr Pulmonol 1997;23:336-343. 85.

56. Gaultier C. Tension-time index of respiratory muscles in children [edi torial]. Pediatr Pulmonol 1997;23:327-329. 86.

57. Gozal D, Shoseyov D, Keens T. Inspiratory pressures with CO2 stimu lation and weaning from mechanical ventilation in children. Am Rev Respir Dis 1993;147:256-261.

58. Stefanutti D, Fitting JW. Sniff nasal inspiratory pressure: reference val- 87.

ues in Caucasian children. Am J Respir Crit Care Med 1999;159:107-111.

59. Shardonofsky F, Perez-chada D, Milic-Emili J. Airway pressures dur ing crying: an index of respiratory muscle strength in infants with 88.

neuromuscular disease. Pediatr Pulmonol 1991;10:172-177.

60. Scott C, Nickerson B, Sargen TC, Platzker A, Warburton D, Keens T.

Developmental pattern of maximal transdiaphagmatic pressure in infants during crying. Pediatr Res 1983;17:707-709. 89.

61. Fisher J, Mortola J, Smith B, Fox G, Weeks S. Respiration in new-

borns: development of the control of breathing. Am Rev Respir Dis 1982;125:650-657. 90.

62. Greenspan J, Wolfson M, Locke R, Allen J, Shaffer T. Increased respi ratory drive and limited adaptation to loaded breathing in broncho-pulmonary dysplasia. Pediatr Res 1992;32:356-359. 91.

63. Gaultier C, Perret L, Boule M, Tournier G, Girard F. Control of breathing in children with interstitial lung diseases. Pediatr Res 1982;16: 779-783.

64. Gaultier C, Perret L, Boule M, Baculard A, Grimfeld A, Girard F. Occlu- 92.

sion pressure and breathing pattern in children with chronic obstructive pulmonary disease. Bull Eur Physiopathol Respir 1982;18:851-862.

65. Roussos C, Fixley M, Gross D, Macklem P. Fatigue of inspiratory mus- 93.

cles and their synergic behavior. J Appl Physiol 1979;46:897-904.

66. Ramonatxo M, Boulard P, Prefaut C. Validation of a noninvasive ten sion-time index of inspiratory muscles. J Appl Physiol 1995;78:646-653.

Bellemare F, Grassino A. Evaluation of the human diaphragmatic fatigue. J Appl Physiol 1982;53:1196-1206.

Boule M, Gaultier C, Girard F. Breathing pattern during exercise in untrained children. Respir Physiol 1989;75:225-234.

Muller N, Volgyesy G, Becker L, Bryan A. The consequence of diaphragmatic muscle fatigue in the newborn infant. J Pediatr 1979;95:793-797.

Muller N, Volgyesi G, Becker L, Bryan M, Bryan A. Diaphragmatic muscle tone. J Appl Physiol 1979;47:279-284.

Praud J, D'Allest A, Nedelcoux H, Curzi-Dascalova L, Guilleminault C, Gaultier C. Sleep-related abdominal behavior during partial or complete obstructed breathing in prepubertal children. Pediatr Res 1989;25:347-350.

Jeffries B, Brouillette R, Hunt C. Electromyographic study of some accessory muscles of respiration in children with obstructive sleep ap-nea. Am Rev Respir Dis 1984;129:696-702.

Reis F, Cates D, Landriault L, Rigatto H. Diaphragmatic activity and ventilation in preterm infants. Biol Neonate 1994;65:16-24.

Chambille B, Vardon G, Monrigal J, Dehan M, Gaultier C. Technique of on-line analysis of diaphragmatic electromyogram activity in the newborn. Eur Respir J 1989;2:883-886.

Nugent S, Finley J. Spectral analysis of the EMG and diaphragmatic muscle fatigue during periodic breathing in infants. J Appl Physiol 1985;58:830-833.

American Thoracic Society. Standards and indications for cardiopul-monary sleep studies in children. Am J Respir Crit Care Med 1996; 153:866-878.

Konno K, Mead J. Measurement of the separate volume changes of the rib cage and abdomen during breathing. J Appl Physiol 1967;22:407-422.

Dolfin T, Duffy P, Wilkes D, Bryan M. Calibration of respiratory inductive plethysmography. Am Rev Respir Dis 1982;125:577-579.

Stefano J, Spizer A, Baumgart S, Davis J, Fox W. Inductive plethys-mography: a facilitated postural calibration technique for rapid and accurate tidal volume determination in low birth weight premature newborns. Am Rev Respir Dis 1986;134:1020-1024.

Sackner M, Warson H, Belsito A, Feinerman D, Suarez M, Gonzalez G, Bizousky F, Krieger B. Calibration of respiratory inductive pleth-ysmograph during natural breathing. J Appl Physiol 1989;66:410-420.

Revow M, England S, Stogryn H, Wilkes D. Comparison of calibration methods for respiratory inductive plethysmography on infants. J Appl Physiol 1987;63:1853-1861.

Mortola J, Sant'Ambrogio G. Motion of the rib cage and the abdomen in tetraplegic patients. Clin Sci Mol Med 1978;54:25-32.

DeTroyer A, Kelly S. Chest wall mechanics in dogs with acute diaphragm paralysis. J Appl Physiol 1982;53:373-379.

Higgenbottam T, Allen D, Loh LC, Clark TJ. Abdominal wall movement in normals and patients with hemidiaphragmatic and bilateral diaphragmatic palsy. Thorax 1977;32:589-595.

Roussos C, Macklem P. The respiratory muscles. N Engl J Med 1982; 307:786-797.

Deoras K, Greenspan J, Wolfson M, Keklikian E, Shaffer T, Allen J. Effects of inspiratory resistive loading on chest wall motion and ventilation: differences between preterm and full-term infants. Pediatr Res 1992;32:589-594.

Allen J, Wolfson M, McDowell K, Shaffer T. Thoracoabdominal asyn-chrony in infants with airflow obstruction. Am Rev Respir Dis 1990; 141:337-342.

Allen J, Greenspan J, Deoras K, Keklikian E, Wolfson M, Shaffer T. Interaction between chest wall and lung mechanics in normal infants and infants with bronchopulmonary dysplasia. Pediatr Pulmonol 1991;11:37-43.

Sivan Y, Deakers T, Newth C. Thoracoabdominal asynchrony in acute upper airway obstruction in small children. Am Rev Respir Dis 1990; 142:540-544.

Benameur M, Goldman M, Eccoffey C, Gaultier C. Ventilation and thoracoabdominal asynchrony during halothane anesthesia in infants. J Appl Physiol 1993;74:1591-1596.

Goldman M, Pagani M, Trang A, Praud J, Sartene R, Gaultier C. Asynchronous chest wall movement during non-rapid eye movement and rapid eye movement sleep in children with bronchopulmonary dys-plasia. Am Rev Respir Dis 1993;147:1175-1184.

Colin A, Hunter J, Stark A, Wohl M. Normal infants and children have minimal thoraco-abdominal asynchrony assessed by respiratory inductive plethysmography. Am Rev Respir Dis 1993;147:A966.

Sackner M, Gonzalez H, Rodriguez M, Belsito A, Sackner D, Grenvik S. Assessment of asynchronous and paradoxic motion between the rib cage and abdomen in normal subjects and in patients with chronic obstructive pulmonary disease. Am Rev Respir Dis 1984;130:588-593.

94. Drinker P, Shaw L. An apparatus for the prolonged administration of artificial respiration. J Clin Invest 1929;7:229-247.

95. Diaz C, Deoras K, Allen J. Chest wall motion before and during me chanical ventilation in children with neuromuscular disease. Pediatr Pulmonol 1993;16:89-95.

96. Weiner P, Suo J, Fernandez E, Cherniack R. The effect of hyperinfla tion on respiratory muscle strength and efficiency in healthy subjects and patients with asthma. Am Rev Respir Dis 1990;141:1501-1505.

97. Stick S, Ellis E, LeSouef P, Sly P. Validation of respiratory inductance plethysmography ("Respitrace") for the measurement of tidal breathing parameters in newborns. Pediatr Pulmonol 1992;14:187-191.

98. Laing I, Teele R, Stark A. Diaphragmatic movement in newborn in fants. J Pediatr 1988;112:638-643.

99. Cohen E, Mier A, Heywood P, Murphy K, Boultbee J. Diaphragmatic movement in hemiplegic patients measured by ultrasonography. Thorax 1994;49:890-895.

100. Froese A, Bryan A. Effect of anaesthesia and paralysis on diaphrag matic mechanism in man. Anesthesiology 1974;41:242-255.

101. Harris R, Giovannetti M, Kim B. Normal ventilatory movement of the right hemidiaphragm studied by ultrasound and pneumotachygra-phy. Radiology 1983;146:141-144.

102. Ross-Russell R, Helps B, Elliot M, Helms P. Phrenic nerve stimulation at the bedside in children: equipment and validation. Eur Respir J 1993;6:1332-1335.

103. Raimbault J. Technique et résultats de l'exploration électromyographique du diaphragme chez le nourrisson et le jeune enfant. Rev Electroen-cephalogr Neurophysiol Clin 1983;13:306-311.

104. Similowski T, Fleury B, Launois S, Cathala H, Bouche P, Derenne J-P.

Stimulation magnetique cervicale (SMC). Rev Mal Respir 1988;5:609-614.

105. Rafferty GF, Greenough A, Dimitriou G, Polkey MI, Long A, Davenport

M, Moxham J. Assessment of neonatal diaphragmatic paralysis using magnetic phrenic nerve stimulation. Pediatr Pulmonol 1999;27:224-226

106. Remmers J, Launois S, Feroah T, Whitelaw W. Mechanics of the phar ynx in patients with obstructive sleep apnea. Prog Clin Biol Res 1991; 345:261-268.

107. Smith T, Baska R, Francisco C, McCray G, Kunz S. Sleep apnea syn drome: diagnosis of upper airway obstruction by fluoroscopy. J Pedi-atr 1978;93:891-892.

108. Schwab R, Gupta K, Gefter W, Metzger L, Hoffman E, Pack A. Upper airway and soft tissue anatomy in normal subjects and patients with sleep-disordered breathing: significance of the lateral pharyngeal walls. Am J Respir Crit Care Med 1995;152:1673-1689.

109. Condos R, Norman R, Krishnasamy I, Peduzzi N, Goldring R, Rapo-

port D. Flow limitation as a noninvasive assessment of residual upper-airway resistance during continuous positive airway pressure of obstructive sleep apnea. Am J Respir Crit Care Med 1994;150: 475-480.

110. Wilson S, Thach B, Brouillette R, Abu-Osba Y. Upper airway patency in human infant: influence of airway pressure and posture. J Appl Physiol 1980;48:500-504.

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