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Biomedical subjects

K Kwiatkowski

Publications and source records attributed to K Kwiatkowski.

8 recordsLinked to original sources
PubMed1992

Effects of inhaled oxygen (up to 40%) on periodic breathing and apnea in preterm infants.

To discover whether increases in inhaled O2 fraction (FIO2; up to 40%) decrease apnea via an increase in minute ventilation (VE) or a change in respiratory pattern, 15 preterm infants (birth weight 1,300 +/- 354 g, gestational age 29 +/- 2 wk, postnatal age 20 +/- 9 days) breathed 21, 25, 30, 35, and 40% O2 for 10 min in quiet sleep. A nosepiece and a flow-through system were used to measure ventilation. Alveolar PCO2, transcutaneous PO2, and sleep states were also assessed. All infants had periodic breathing with apneas greater than or equal to 3 s. With an increase in FIO2 breathing became more regular and apneas decreased (P less than 0.001). This regularization in breathing was not associated with significant changes in VE. However, the variability of VE, tidal volume, and expiratory and inspiratory times decreased significantly. The results indicate that the more regular breathing observed with small increases in FIO2 was not associated with significant changes in ventilation. The findings suggest that the increased oxygenation decreases apnea and periodicity in preterm infants, not via an increase in ventilation, but through a decrease in breath-to-breath variability of VE.

Apnea↗
PubMed1992

A respiratory sensory reflex in response to CO2 inhibits breathing in preterm infants.

Traditionally, the increase in ventilation occurring after approximately 4 s of CO2 inhalation in preterm infants has been attributed to an action at the peripheral chemoreceptors. However, on a few occasions, we have observed a short apnea (2-3 s) in response to 3-5% CO2 in these infants. To test the hypothesis that this apnea reflects a respiratory sensory reflex to CO2, we gave nine preterm infants [birth wt 1.5 +/- 0.1 (SE) kg, gestational age 31 +/- 1 wk] 7-8% CO2 while they breathed 21% O2. To study the dose-response relationship, we also gave 2, 4, 6, and 8% CO2 to another group of seven preterm infants (birth wt 1.5 +/- 0.1 kg, gestational age 31 +/- 1 wk). In the first group of infants, minute ventilation during 21% O2 breathing (0.232 +/- 0.022 l.min-1.kg-1) decreased after CO2 administration (0.140 +/- 0.022, P < 0.01) and increased with CO2 removal (0.380 +/- 0.054, P < 0.05). This decrease in ventilation was related to an apnea (12 +/- 2.6 s) occurring 7.7 +/- 0.8 s after the beginning of CO2 inhalation. There was no significant change in tidal volume. In the second group of infants, minute ventilation increased during administration of 2, 4, and 6% CO2 but decreased during 8% CO2 because of the presence of an apnea. These findings suggest that inhalation of a high concentration of CO2 (> 6%) inhibits breathing through a respiratory sensory reflex, as described in adult cats (H. A. Boushey and P. S. Richardson. J. Physiol. Lond. 228: 181-191, 1973).(ABSTRACT TRUNCATED AT 250 WORDS)

Apnea↗
PubMed1992

Speed and profile of the arterial peripheral chemoreceptors as measured by ventilatory changes in preterm infants.

To measure the response time of the peripheral chemoreceptors, we studied 13 preterm infants [birth weight 1602 +/- 230 g (mean +/- SEM); gestational age 31 +/- 1 wk; postnatal age 15 +/- 1 d] during inhalation of 21% O2 (15 +/- 5 s) followed by 100% O2 (1 min). We used a flow-through system to measure ventilation and gas analyzers to measure alveolar gases. Hypoventilation was observed at 3.6 +/- 0.6 s and was maximal at 6.8 +/- 1 s after O2 began. This maximal response was always associated with an apnea (greater than 3 s). Alveolar PO2 increased from 13.5 +/- 0.1 kPa (101 +/- 0.8 torr) (control) to 28.0 +/- 1.2 kPa (210 +/- 9 torr) (1st O2 breath), to 42.0 +/- 2.4 kPa (315 +/- 18 torr) (1st hypoventilation), to 45.9 +/- 4.1 kPa (344 +/- 31 torr) (breath preceding maximal response), and to 53.6 +/- 4.1 kPa (402 +/- 31 torr) (at maximal response). Minute ventilation was 0.192 +/- 0.011 (control), 0.188 +/- 0.011 (1st O2 breath), 0.088 +/- 0.016 (1st hypoventilation; p less than 0.0001), 0.122 +/- 0.016 (breath preceding maximal response; p less than 0.0002), and 0.044 +/- 0.011 L/min/kg at maximal response (p less than 0.0001). This decrease in ventilation was due to a decrease in frequency with no appreciable change in tidal volume. The initial period of hypoventilation (19 +/- 4 s) was followed by a breathing interval (10 +/- 2 s) and a second period of hypoventilation (14 +/- 3 s) before continuous breathing resumed.(ABSTRACT TRUNCATED AT 250 WORDS)

Arteries↗
PubMed1992

Small preterm infants (less than or equal to 1500 g) have only a sustained decrease in ventilation in response to hypoxia.

The classic "biphasic" ventilatory response to 15% O2 was previously observed in preterm infants who were large compared with those in the intensive care nursery today. We hypothesized that in the smaller infant (less than or equal to 1500 g) the response might be closer to that of the fetus, with no initial increase in ventilation. Thus, we studied 14 healthy preterm infants less than or equal to 1500 g [birth weight 1200 +/- 63 g (mean +/- SEM); gestational age 29 +/- 0.4 wk; postnatal age 17 +/- 3 d] during rapid eye movement and quiet sleep. Ventilation was measured using a nosepiece and a flow-through system. Sleep states were defined using EEG, electro-oculogram, and body movements. After a control period in 21% O2 (3 min), infants breathed 15% O2 for 5 min. In rapid eye movement sleep, minute ventilation decreased from 0.186 +/- 0.020 (control) to 0.178 +/- 0.021 (30 s), to 0.171 +/- 0.017 (1 min; p = 0.03), to 0.145 +/- 0.016 (3 min; p = 0.002), and to 0.129 +/- 0.011 l.min-1.kg-1 (5 min; p = 0.004). In quiet sleep, it decreased from 0.173 +/- 0.019 (control) to 0.164 +/- 0.019 (30 s), to 0.166 +/- 0.019 (1 min), to 0.148 +/- 0.013 (3 min; p = 0.03), and to 0.146 +/- 0.012 l.min-1.kg-1 (5 min; p = 0.04).(ABSTRACT TRUNCATED AT 250 WORDS)

Humans↗
PubMed1991

Clinical and physiological responses to prolonged nasogastric administration of doxapram for apnea of prematurity.

We hypothesized that enteral doxapram would effectively treat apnea of prematurity without the appearance of major side effects. Of 16 infants, 10 (BW 1,520 +/- 102 g) received doxapram alone and 6 (BW 1,020 +/- 35 g) received doxapram plus theophylline. Apneas decreased from 16.7 +/- 1.9 to 2.1 +/- 0.6 in infants receiving doxapram alone, and from 38.2 +/- 4.4 to 7.9 +/- 2.2 apneas/24 h in those receiving doxapram plus theophylline. This was associated with an increase in alveolar ventilation, a shift of the ventilatory response to CO2 to the left, and no change in the immediate ventilatory response to 100% oxygen. Side effects included premature teeth buds corresponding to the lower central incisors, prevalence of occult blood in stool and necrotizing enterocolitis. The findings suggest that doxapram effectively controls apnea when given enterally, but should be used cautiously because of potentially harmful side effects.

Apnea↗
PubMed1990

[Esophagotracheal fistula as a complication of radiotherapy of lung cancer].

A case report is presented of a patient with lung cancer treated with chemotherapy followed by radiotherapy due to increasing dysphagia. A few months after radioterapy an esophago-tracheal fistula developed, which was diagnosed by a radiological contrast study and esophagofiberoscopy. Post mortem examination did not reveal malignant invasion of the fistula and surrounding tissues. It seems that the fistula was a late complication of radiotherapy.

Cobalt Radioisotopes↗
PubMed1989

Hypoxic airway constriction in infants of very low birth weight recovering from moderate to severe bronchopulmonary dysplasia.

We hypothesized that infants recovering from severe bronchopulmonary dysplasia have airway constriction that is, at least in part, related to borderline hypoxia. If this hypothesis were correct, pulmonary resistance should decrease with the administration of oxygen. To test this hypothesis, we studied 10 infants recovering from severe bronchopulmonary dysplasia (study weight 2490 +/- 275 gm; birth weight 1010 +/- 89 gm; postnatal age 73 +/- 7 days; postconceptional age 38.5 +/- 1.6 weeks) and 10 matched control infants (study weight 2430 +/- 179 gm; birth weight 2320 +/- 195 gm; postnatal age 25 +/- 4 days; postconceptional age 37.5 +/- 0.8 weeks). Resistance and compliance were measured by means of a mask with a flowmeter and an esophageal balloon (with the PEDS computer program). Measurements in both groups were made in quiet sleep, without sedation, during the inhalation of room air and during the fifth minute of oxygen inhalation. We found that (1) total pulmonary resistance, significantly higher in infants with bronchopulmonary dysplasia than in control infants, decreased from 206.1 +/- 47 cm H2O.L-1.sec-1 during inhalation of room air to 106.5 +/- 20.9 during inhalation of 100% oxygen (p less than 0.05) and (2) pulmonary dynamic compliance, lower in infants with bronchopulmonary dysplasia than in control infants, increased significantly with the administration of 100% oxygen. The results suggest that infants with bronchopulmonary dysplasia have airway constriction and that this is alleviated by inhalation of oxygen.

Airway Obstruction↗