A Comprehensive Integrated Testing Protocol (CITP) incorporates precise measurements of the dynamic and the static
lung volumes and capacities at V30 for routine infant
lung function testing. The static
functional residual capacity (sFRC) in infants is measured after a short hyperventilation induces a post-hyperventilation
apnea (PHA) that abolishes the infant's
breathing strategies and creates a reliable volume
landmark. A measurement of the sFRC is then obtained by
inert gas
washout; e.g., by measuring the volume of
nitrogen expired after end-passive expiratory switching of the
inspired gas from room air to 100%
oxygen during the PHA. A true measurement of the total
lung capacity (TLC) is obtained from the sum of (1) the passively exhaled gas volume from a Pao
plateau of 30 cm H2O through a pneumotachometer (PNT) by integrating the flow
signal to produce volume, which is the
inspiratory capacity (IC), and (2) the sFRC. From intrasubject TLC and
residual volume (RV), the difference is a reliable estimate of the slow
vital capacity (SVC). Similar measurements may be obtained with a fastened squeeze jacket for comparison. Actual
airway opening pressure (
aPao) is measured during a 0.20 s
airway occlusion after halting the inflating
airflow and prior to activating the jacket inflation. An
open mouth is maintained during forced expiration in order to generate an oronasal instead of a forced expiration.