Effect of nasal airway nonlinearities on oscillometric resistance measurements in infants

Abstract

Oscillometric measurements of respiratory system resistance (Rrs) in infants are usually made via the nasal pathways, which not only significantly contribute to overall Rrs but also introduce marked flow (V=)-dependent changes. We employed intrabreath oscillometry in casts of the upper airways constructed from head CT images of 46 infants. We examined oscillometric nasal resistance (Rn) in upper airway casts with no respiratory flow (R0) and the effect of varying V= on Rn by simulating tidal breathing. A characteristic nonlinear relationship was found between Rn and V=, exhibiting segmental linearity and a prominent breakpoint (V=bp) after log-log transformation. V=bp was linearly related to the preceding value of end-expiratory volume acceleration (V〞eE; on average r2 ＝ 0.96, P ＜ 0.001). Rn depended on V=, and R at end-expiration (ReE) showed a strong dependence on V〞eE in every cast (r2 ＝ 0.994, P ＜ 001) with considerable interindividual variability. The intercept of the linear regression of ReE versus V〞eE was found to be a close estimate of R0. These findings were utilized in reanalyzed Rrs data acquired in vivo in a small group of infants (n ＝15). Using a graphical method to estimate R0 from ReE, we found a relative contribution of V=-dependent nonlinearity to total resistance of up to 33%. In conclusion, we propose a method for correcting the acceleration-dependent nonlinearity error in ReE. This correction can be adapted to estimate R0 from a single intrabreath oscillometric measurement, which would reduce the masking effects of the upper airways on the changes in the intrathoracic resistance. NEW & NOTEWORTHY Oscillometric measurements of respiratory system resistance (Rrs) in infants are usually made via the nasal pathways, which not only significantly contribute to overall Rrs but also introduce marked flow acceleration-dependent distortions. Here, we propose a method for correcting flow acceleration-dependent nonlinearity error based on in vitro measurements in 3D-printed upper airway casts of infants as well as in vivo measurements. This correction can be adapted to estimate Rrs from a single intrabreath oscillometric measurement.