Developmental Respiratory Physiology

Overview

Journal Paediatr Anaesth

Specialties Anesthesiology
Pediatrics

Date 2021 Dec 8

PMID 34877744

Citations 18

Authors

Daniel Trachsel

Thomas O Erb

Jurg Hammer

Britta S von Ungern-Sternberg

Affiliations

Soon will be listed here.

Abstract

Various developmental aspects of respiratory physiology put infants and young children at an increased risk of respiratory failure, which is associated with a higher rate of critical incidents during anesthesia. The immaturity of control of breathing in infants is reflected by prolonged central apneas and periodic breathing, and an increased risk of apneas after anesthesia. The physiology of the pediatric upper and lower airways is characterized by a higher flow resistance and airway collapsibility. The increased chest wall compliance and reduced gas exchange surface of the lungs reduce the pulmonary oxygen reserve vis-à-vis a higher metabolic oxygen demand, which causes more rapid oxygen desaturation when ventilation is compromised. This review describes the various developmental aspects of respiratory physiology and summarizes anesthetic implications.

Citing Articles

The High Prevalence of Continuous Paradoxical Breathing During Sleep in Children With Obesity and Its Relationship With Obstructive Sleep Apnea.

Al-Naimi A, Asir N, Belavendra A, Janahi I, Abushahin A, Abu-Hasan M Cureus. 2025; 17(1):e77479.

PMID: 39958027 PMC: 11828704. DOI: 10.7759/cureus.77479.

Observational Study on the Clinical Reality of Community-Acquired Respiratory Virus Infections in Adults and Older Individuals.

Nagasawa M, Udagawa T, Kato T, Tanaka I, Yamamoto R, Sakaguchi H Pathogens. 2024; 13(11).

PMID: 39599536 PMC: 11597395. DOI: 10.3390/pathogens13110983.

Incidence and factors associated with prolonged use of mechanical ventilation in pediatric intensive care unit in a single tertiary care hospital.

Pisitcholakarn V, Sunkonkit K, Reungrongrat S PLoS One. 2024; 19(11):e0311275.

PMID: 39527535 PMC: 11554204. DOI: 10.1371/journal.pone.0311275.

Lung ultrasound assessment of atelectasis following different anesthesia induction techniques in pediatric patients: a propensity score-matched, observational study.

Camporesi A, Roveri G, Vetrugno L, Buonsenso D, De Giorgis V, Costanzo S J Anesth Analg Crit Care. 2024; 4(1):69.

PMID: 39369249 PMC: 11452973. DOI: 10.1186/s44158-024-00206-x.

Commercial infant products influence body position and muscle use.

Siegel D, Goldrod S, Wilson C, Bossert A, Lujan T, Whitaker B Early Hum Dev. 2024; 198:106122.

PMID: 39305831 PMC: 11560562. DOI: 10.1016/j.earlhumdev.2024.106122.

References

Balinotti J, Tiller C, Llapur C, Jones M, Kimmel R, Coates C . Growth of the lung parenchyma early in life. Am J Respir Crit Care Med. 2008; 179(2):134-7. PMC: 2633059. DOI: 10.1164/rccm.200808-1224OC. View

Mirza H, Varich L, Sensakovic W, Guruvadoo K, Royall I, Britt C . Tracheomegaly among Extremely Preterm Infants on Prolonged Mechanical Ventilation. J Pediatr. 2019; 218:231-233.e1. DOI: 10.1016/j.jpeds.2019.10.024. View

Hannam S, Ingram D, Rabe-Hesketh S, Milner A . Characterisation of the Hering-Breuer deflation reflex in the human neonate. Respir Physiol. 2000; 124(1):51-64. DOI: 10.1016/s0034-5687(00)00184-5. View

Kato I, Franco P, Groswasser J, Kelmanson I, Togari H, Kahn A . Frequency of obstructive and mixed sleep apneas in 1,023 infants. Sleep. 2000; 23(4):487-92. View

von Ungern-Sternberg B, Frei F, Hammer J, Schibler A, Doerig R, Erb T . Impact of depth of propofol anaesthesia on functional residual capacity and ventilation distribution in healthy preschool children. Br J Anaesth. 2007; 98(4):503-8. DOI: 10.1093/bja/aem002. View

Bhananker S, Ramamoorthy C, Geiduschek J, Posner K, Domino K, Haberkern C . Anesthesia-related cardiac arrest in children: update from the Pediatric Perioperative Cardiac Arrest Registry. Anesth Analg. 2007; 105(2):344-50. DOI: 10.1213/01.ane.0000268712.00756.dd. View

Sankaran K, Wiebe H, Seshia M, Boychuk R, Cates D, Rigatto H . Immediate and late ventillatory response to high and low O2 in preterm infants and adult subjects. Pediatr Res. 1979; 13(8):875-8. DOI: 10.1203/00006450-197908000-00001. View

Marcus C, Prado L, Lutz J, Katz E, Black C, Galster P . Developmental changes in upper airway dynamics. J Appl Physiol (1985). 2004; 97(1):98-108. DOI: 10.1152/japplphysiol.00462.2003. View

Burri P . Structural aspects of postnatal lung development - alveolar formation and growth. Biol Neonate. 2006; 89(4):313-22. DOI: 10.1159/000092868. View

10.

Reyes A, SYKES M, Chakrabarti M, Tait A, Petrie A . The effect of salbutamol on hypoxic pulmonary vasoconstriction in dogs. Bull Eur Physiopathol Respir. 1978; 14(6):741-53. View

11.

von Ungern-Sternberg B, Regli A, Frei F, Hammer J, Jordi Ritz E, Erb T . Decrease in functional residual capacity and ventilation homogeneity after neuromuscular blockade in anesthetized preschool children in the lateral position. Paediatr Anaesth. 2007; 17(9):841-5. DOI: 10.1111/j.1460-9592.2007.02226.x. View

12.

Oliveira A, Nunes M, Fojo-Olmos A, Reis F, Da Costa J . Clinical correlates of periodic breathing in neonatal polysomnography. Clin Neurophysiol. 2004; 115(10):2247-51. DOI: 10.1016/j.clinph.2004.05.007. View

13.

Kohler M, Kriemler S, Wilhelm E, Brunner-LaRocca H, Zehnder M, Bloch K . Children at high altitude have less nocturnal periodic breathing than adults. Eur Respir J. 2008; 32(1):189-97. DOI: 10.1183/09031936.00119807. View

14.

Greenberg R, Zahurak M, Belden C, Tunkel D . Assessment of oropharyngeal distance in children using magnetic resonance imaging. Anesth Analg. 1998; 87(5):1048-51. DOI: 10.1097/00000539-199811000-00014. View

15.

Lopes J, Muller N, Bryan M, Bryan A . Importance of inspiratory muscle tone in maintenance of FRC in the newborn. J Appl Physiol Respir Environ Exerc Physiol. 1981; 51(4):830-4. DOI: 10.1152/jappl.1981.51.4.830. View

16.

Thurlbeck W, ANGUS G . Growth and aging of the normal human lung. Chest. 1975; 67(2 Suppl):3S-6S. DOI: 10.1378/chest.67.2_supplement.3s. View

17.

Neumann R, von Ungern-Sternberg B . The neonatal lung--physiology and ventilation. Paediatr Anaesth. 2013; 24(1):10-21. DOI: 10.1111/pan.12280. View

18.

Montravers P, Dureuil B, Desmonts J . Effects of i.v. midazolam on upper airway resistance. Br J Anaesth. 1992; 68(1):27-31. DOI: 10.1093/bja/68.1.27. View

19.

Green M, Mead J, Turner J . Variability of maximum expiratory flow-volume curves. J Appl Physiol. 1974; 37(1):67-74. DOI: 10.1152/jappl.1974.37.1.67. View

20.

Ono T, Otsuka R, Kuroda T, Honda E, Sasaki T . Effects of head and body position on two- and three-dimensional configurations of the upper airway. J Dent Res. 2001; 79(11):1879-84. DOI: 10.1177/00220345000790111101. View