EFFECT OF CONTINUOUS POSITIVE AIRWAY PRESSURE ON FORCED EXPIRATORY FLOWS IN INFANTS WITH TRACHEOMALACIA

Continuous positive airway pressure (CPAP) is used to minimize airway collapse in infants with tracheomalacia. Forced expiratory flows (FEFs ) at functional residual capacity (FRC) increase with increasing CPAP in infants with tracheomalacia, and it has been suggested that CPAP pr events airway collapse by ''stenting'' the airway open. Since FEF is g reater at higher than at lower lung volumes, we evaluated whether the increase in flow measured at FRC ((V) over dot FRC) With CPAP could be explained by the increase in FRC with CPAP. We measured full FEF-volu me curves at CPAP levels of 0, 4, and 8 cm H2O in six infants with tra cheomalacia and five healthy control infants. In both groups of infant s, FVC did not change with CPAP; however, inspiratory capacity (IC) de creased and thus FRC increased with increasing CPAP. FEFs at FRC incre ased with increasing levels of CPAP; however, the FEFs at 50% and 75% of expired volume were not different for the three levels of CPAP for both groups of infants. Our finding that FEFs measured at the same lun g volumes did not differ for the different levels of CPAP indicates th at CPAP affects forced flows primarily by increasing lung volume.