Thoracoabdominal asynchrony in acute upper airway obstruction in small children

The assessment of the severity and response to therapy of acute upper airway obstruction (UAO) in small children relies on subjective parameters. Using a noncalibrated respiratory inductance plethysmograph (RIP), we quantitated the rib cage (RC) to abdominal (AB) asynchrony and the lag phase in chest wall expansion by the phase angle from the RC versus AB signal curve. Phase angles were obtained in 17 children aged 1 to 50 months with acute UAO and 30 normal control subjects. The phase angle in UAO (16 to 165°; mean = 83.6°) was significantly higher than in control subjects (3 to 25°; mean = 11.5°), p < 0.001. Following 29 episodes of inhalation treatment with 0.03 ml/kg of racemic epinephrine, the phase angle in the UAO group decreased to 7 to 160° (mean = 38.3; p = 0.001) as the shape of the RC versus AB loop became narrower. In response to the treatment, the clinical severity of UAO decreased and the tidal breathing flow-volume loop improved. A high association was observed between the phase angle and the degree of stridor (p < 0.005 Fisher's exact test), and in 90% (26 of 29) the changes in the phase angle and in the degree of stridor were in agreement. We conclude that the RC-AB asynchrony in acute UAO can be objectively quantitated by phase-angle measurement from a noncalibrated RIP and is thus suitable for use in infants and small children. The phase angle may be used to assess objectively the response of UAO to therapy.