Lung sounds in neonates with and without an added dead space

Previous studies have reported great difficulty in recording lung sounds from neonates and have found conflicting results. We studied lung sounds in neonates during the inspiratory phase of the respiratory cycle as monitored by inductive plethysmography (A) and by pneumotachograph and face mask (8) which added dead space of 12 mL. Sixteen term babies were tested 12 hr to 6 days (median 45 hours) after birth. Lung sounds were recorded and then analysed using overlapping and nonoverlapping fast Fourier transforms. The two methods of analysis showed difference in intensity but not in frequency. Fourteen babies provided enough breaths for comparison; total of 596 inspirations were analysed. The intensity of lung sounds on occasion B was higher in all but two babies with mean B/A ratio of 2.4. The mean (SD) power on occasions A and B was 13.9(8.5) mW and 26.9 (21.0) mW, P = 0.02, respectively. In all but 4 babies the B/A ratios of the median (f₅₀) and 90th centile (f₉₀) frequencies were scattered randomly within 20% of unity. The mean (SD) f₅₀ on occasions A and B was 205.5 (51.1) Hz and 225.8 (32.3) Hz, P = 0.10, respectively; the mean f₅₀ was 370.3 (91.0) Hz and 396.1 (67.8) Hz, P = 0.25, respectively. Linear regression showed that there is third-order polynomial relationship between sound intensity and air flow at the mouth. A weaker positive association exists between frequency and air flow, showing that the median and 90th centile frequencies approach an asymptote as flow increases. We conclude that adding dead space increases the intensity of lung sounds in neonates due to increased flow, but has no consistent effect on frequency content. © 1995 Wiley-Liss, Inc.     

Mercury Complexation with Dissolved Organic Matter Released from Thirty-Six Types of Biochar

Previous studies show mercury (Hg) can be effectively removed from solution by biochar, but limited attention was paid on the complexation between Hg and components released from biochars, e.g. dissolved organic matter (DOM). Here, aqueous data from batch-style experiments were modeled using PHREEQC, incorporating thermodynamic constants between Hg and DOM, which was assumed to be composed of thiol, carboxylic, and phenolic functional groups. Modelling results suggest that > 99% Hg complexed with thiol groups in DOM. The modelled concentrations of Hg–DOM complexes from low-T (low-temperature, 300°C) biochars were greater than from high-T (600°C) biochars. The concentrations of Hg–DOM complexes were lower in wood-based than in agricultural residue- and manure-based biochars. Hg–DOM complexes may affect Hg speciation, bioavailability, transport, and methylation processes. This research describes a method to evaluate Hg–DOM interactions, and the results indicate extra caution regarding Hg–DOM complex formation is required in the selection of biochar for Hg remediation.

     

Airway resistance estimation by best fit analysis in very premature infants

Plethysmographic measurement of airway resistance (R(aw)) has been determined by single-point analysis, usually at 50% of maximum inspiratory flow (MIF). Computer-assisted (best fit) analysis, however, allows R(aw) to be calculated by applying a regression line to any portion of the plethysmograph pressure-flow loop. We determined whether the results of best fit analysis using a computer program, sampling at 200 Hz, were influenced by the portion of the inspiratory loop analysed and if best fit or single-point analysis gave more reproducible results. Twenty infants of median gestational age 26 (range 24-28) weeks, were studied at a median age of 12 (12-14) months corrected for prematurity. R(aw) was calculated by best fit analysis between 0 and 33% MIF, 0 and 50% MIF and 0 and 67% MIF and single-point analysis at 50% of MIF. Similar mean R(aw) values were obtained by best fit analysis between 0 and 33% MIF (2.79 kPa/(l/s)) and 0 and 50% MIF (3.01 kPa/(l/s)) and single-point analysis at 50% MIF (2.86 kPa/(l/s)), but best fit analysis between 0 and 67% gave higher results (3.60 kPa/(l/s)), p < 0.0001. Within the linear portion of the inspiratory loop, the mean intrasubject coefficient of variation was lowest for best fit analysis between 0 and 50% MIF. Best fit computerized analysis between 0 and 50% MIF is recommended as the analysis of choice.     

Plethysmograph and interrupter resistance measurements in prematurely born young children

BACKGROUND: Airways obstruction in premature infants is often assessed by plethysmography, which requires sedation. The interrupter (Rint) technique does not require sedation, but has rarely been examined in children under 2 years of age. OBJECTIVE: To compare Rint results with plethysmographic measurements of airway resistance (Raw) in prematurely born, young children. DESIGN: Prospective study. SETTING: Infant and Paediatric Lung Function Laboratories. PATIENTS: Thirty children with a median gestational age of 25-29 weeks and median postnatal age of 13 months. Interventions and MAIN OUTCOME MEASURES: The infants were sedated, airway resistance was measured by total body plethysmography (Raw), and Rint measurements were made using a MicroRint device. Further Raw and Rint measurements were made after salbutamol administration if the children remained asleep. RESULTS: Baseline measurements of Raw and Rint were obtained from 30 and 26 respectively of the children. Mean baseline Rint values were higher than mean baseline Raw results (3.45 v 2.84 kPa/l/s, p = 0.006). Limits of agreement for the mean difference between Rint and Raw were -1.52 to 2.74 kPa/l/s. Ten infants received salbutamol, after which the mean Rint result was 3.6 kPa/l/s and mean Raw was 3.1 kPa/l/s (limits of agreement -0.28 to 1.44 kPa/l/s). CONCLUSION: The poor agreement between Rint and Raw results suggests that Rint measurements cannot substitute for plethysmographic measurements in sedated prematurely born infants.     

Determination of resonance frequency of the respiratory system in respiratory distress syndrome

AIM: To measure tidal volume delivery produced by high frequency oscillation (HFO) at a range of frequencies including the resonance frequency. METHODS: Eighteen infants with respiratory distress syndrome were recruited (median gestation 28.7 weeks). Each was ventilated at frequencies between 8 and 30 Hertz. Phase analysis was performed at various points of the respiratory cycle. HFO was provided by a variable speed piston device. Resonance frequency was determined from the phase relation between the cyclical movements of the piston and pressure changes at the airway opening. Tidal volume was measured using a jacket plethysmograph. RESULTS: The results were most reproducible when analysis was performed at the end of inspiration (within 1 Hz in nine out of 10 cases). Comparison between tidal volume delivery at 10 Hz and resonance frequency was made in 10 subjects. Delivery was significantly higher at resonance than at 10 Hertz (mean percentage increase 92%, range 9-222%). CONCLUSIONS: These preliminary findings suggest that there is improved volume delivery at resonance frequency.