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Infant lung function: criteria for selecting tidal flow–volume loops

Karen Eline Stensby Bains, Hrefna Katrín Gudmundsdóttir, Martin Färdig, Erik Amnö, Christine M. Jonassen, Björn Nordlund, Eva Maria Rehbinder, Håvard O. Skjerven, Corina Silvia Rueegg, Riyas Vettukattil, Karin C. Lødrup Carlsen
ERJ Open Research 2022 8: 00165-2022; DOI: 10.1183/23120541.00165-2022
Karen Eline Stensby Bains
1University of Oslo, Faculty of Medicine, Institute of Clinical Medicine, Oslo, Norway
2Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
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Hrefna Katrín Gudmundsdóttir
1University of Oslo, Faculty of Medicine, Institute of Clinical Medicine, Oslo, Norway
2Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
9These authors contributed equally, and share second authorship
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Martin Färdig
3Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
4Dept of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
9These authors contributed equally, and share second authorship
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Erik Amnö
3Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
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Christine M. Jonassen
5Faculty of Chemistry, Biotechnology and Food Science, Norwegian University of Life Sciences, Ås, Norway
6Centre for Laboratory Medicine, Østfold Hospital Trust, Kalnes, Norway
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Björn Nordlund
3Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
4Dept of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
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  • ORCID record for Björn Nordlund
Eva Maria Rehbinder
1University of Oslo, Faculty of Medicine, Institute of Clinical Medicine, Oslo, Norway
7Dept of Dermatology, Oslo University Hospital, Oslo, Norway
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  • ORCID record for Eva Maria Rehbinder
Håvard O. Skjerven
1University of Oslo, Faculty of Medicine, Institute of Clinical Medicine, Oslo, Norway
2Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
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Corina Silvia Rueegg
8Oslo Centre for Biostatistics and Epidemiology, Oslo University Hospital, Oslo, Norway
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Riyas Vettukattil
1University of Oslo, Faculty of Medicine, Institute of Clinical Medicine, Oslo, Norway
2Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
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Karin C. Lødrup Carlsen
1University of Oslo, Faculty of Medicine, Institute of Clinical Medicine, Oslo, Norway
2Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
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  • For correspondence: karen.eline.sh@gmail.com
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  • FIGURE 1
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    FIGURE 1

    Criteria for inclusion and exclusion of loops in a test. VT: tidal volume; tE: expiratory time; tI: inspiratory time; PTEF: peak tidal expiratory flow.

  • FIGURE 2
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    FIGURE 2

    Tidal flow–volume loops. a) Examples of excluded loops (red) due to deviating volume (left), notch on expiratory flow (middle) and two expiratory flow peaks (right); b) tidal flow–volume test before (left) and after (right) manual selection of loops. tPTEF: time to peak tidal expiratory flow; tE: expiratory time.

  • FIGURE 3
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    FIGURE 3

    Rater agreement with the mean intraclass correlation (ICC) (95% CI) for a) ratio of time to peak tidal expiratory flow (tPTEF)/expiratory time (tE), b) respiratory rate, c) tidal volume (VT) and d) expiratory volume (VE). Data are presented as individual mean±sd.

Tables

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  • TABLE 1

    Characteristics for the 57 infants with tidal flow–volume measures assessed by three independent raters

    Boys36 (63.2)
    Gestational age at birth (weeks)39.8 (36.6–42.9)
    Birthweight (kg)3.6 (2.8–4.9)
    Birth length (cm)51 (48.0–56.0)
    Weight at 3 months (kg)6.2 (4.57–8.18)
    Length at 3 months (cm)62 (56.5–67.9)

    Data are presented as n (%) or mean (range).

    • TABLE 2

      The number of loops evaluated per rater in the 52 tests that all three raters found appropriate for further analyses, and tests including ≥10 loops

      Number of testsNumber of loops
      All raters
       Rater 15225 (3–53)
       Rater 25226 (3–67)
       Rater 35215 (2–52)
      Tests including ≥10 loops
       Rater 14530 (10–53)
       Rater 24429 (11–67)
       Rater 33724 (10–52)

      Data are presented as n or median (range).

      • TABLE 3

        Number of loops and ratio of time to peak tidal expiratory flow (tPTEF) to expiratory time (tE), respiratory rate, tidal volume per kilogram (VT·kg−1) and expiratory volume (VE) per rater for infants where data from tests were saved by all three raters, all infants where data were saved by one rater and data selected by the software

        InfantsNumber of loopstPTEF/tERespiratory rate (breaths·min−1)VT·kg−1VE (mL)
        All raters
         Rater 15225 (3–53)0.39±0.0867±13.46.4±2.139.1±12.2
         Rater 25226 (3–67)0.41±0.0866±13.16.7±2.140.2±12.2
         Rater 35215 (2–52)0.39±0.0965±13.66.9±2.141.5±12.0
        Data saved by one rater
         Rater 15423 (3–53)0.39±0.0867±13.36.3±2.238.4±12.5
         Rater 25625 (1–67)0.43±0.1166±13.06.4±2.238.9±12.9
         Rater 35215 (2–52)0.39±0.0965±13.66.9±2.141.5±12.0
        Spiroware568 (1–44)0.52±0.2264±14.45.4±2.029.3±10.2

        Data are presented as n, median (range) or mean±sd.

        • TABLE 4

          Conclusion by raters on quality of tests from all 57 infants

          SuccessfulPartly successfulNot successfulTotal number of infants
          3 raters agreed371341
          2 raters agreed58013
          No agreement4#8#10#3

          #: concluded by one rater.

          • TABLE 5

            An overview of all infants with rater disagreement on the quality of the test

            InfantQuality of testLoops before selectionLoops after selectiontPTEF/tEVT·kg−1 (mL)
            1
             Rater 1Successful60300.444.6
             Rater 2Successful220.495.4
             Rater 3Partly successful130.475.6
            6
             Rater 1Partly successful4450.446.6
             Rater 2Partly successful90.556.9
             Rater 3Not successful30.458.3
            8
             Rater 1Partly successful3280.42.4
             Rater 2Partly successful80.372.4
             Rater 3Not successful0
            9
             Rater 1Partly successful3830.467.4
             Rater 2Partly successful50.536.5
             Rater 3Not successful20.517.7
            13
             Rater 1Partly successful6060.3811.6
             Rater 2Successful150.4412.1
             Rater 3Partly successful70.3911.8
            15
             Rater 1Successful60190.547.3
             Rater 2Successful260.577.4
             Rater 3Partly successful80.527.4
            22
             Rater 1Partly successful6050.314.9
             Rater 2Partly successful70.355.1
             Rater 3Not successful40.255.4
            24
             Rater 1Successful60120.416.7
             Rater 2Successful200.468.4
             Rater 3Partly successful50.377.4
            35
             Rater 1Successful60180.454.9
             Rater 2Partly successful60.456.1
             Rater 3Not successful30.517.1
            39
             Rater 1Partly successful1430.443.3
             Rater 2Partly successful40.473.8
             Rater 3Not successful0
            40
             Rater 1Successful38110.395.9
             Rater 2Partly successful110.476.4
             Rater 3Not successful30.476
            41
             Rater 1Successful40110.315.5
             Rater 2Successful130.365.2
             Rater 3Partly successful70.296.1
            47
             Rater 1Partly successful4250.264.4
             Rater 2Partly successful40.325.3
             Rater 3Not successful30.264.6
            48
             Rater 1Successful50120.66.9
             Rater 2Successful110.597.4
             Rater 3Partly successful50.67.5
            51
             Rater 1Successful56100.382.9
             Rater 2Partly successful70.514.6
             Rater 3Not successful40.395.7
            53
             Rater 1Partly successful3130.341.6
             Rater 2Partly successful30.341.6
             Rater 3Not successful20.321.7

            tPTEF: time to peak tidal expiratory flow; tE: expiratory time; VT·kg−1: tidal volume per kilogram.

            Supplementary Materials

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              Please note: supplementary material is not edited by the Editorial Office, and is uploaded as it has been supplied by the author.

              Supplementary material 00165-2022.SUPPLEMENT

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            Infant lung function: criteria for selecting tidal flow–volume loops
            Karen Eline Stensby Bains, Hrefna Katrín Gudmundsdóttir, Martin Färdig, Erik Amnö, Christine M. Jonassen, Björn Nordlund, Eva Maria Rehbinder, Håvard O. Skjerven, Corina Silvia Rueegg, Riyas Vettukattil, Karin C. Lødrup Carlsen
            ERJ Open Research Oct 2022, 8 (4) 00165-2022; DOI: 10.1183/23120541.00165-2022

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            Infant lung function: criteria for selecting tidal flow–volume loops
            Karen Eline Stensby Bains, Hrefna Katrín Gudmundsdóttir, Martin Färdig, Erik Amnö, Christine M. Jonassen, Björn Nordlund, Eva Maria Rehbinder, Håvard O. Skjerven, Corina Silvia Rueegg, Riyas Vettukattil, Karin C. Lødrup Carlsen
            ERJ Open Research Oct 2022, 8 (4) 00165-2022; DOI: 10.1183/23120541.00165-2022
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