The Hering-Breuer reflex in anesthetized infants: end-inspiratory vs. end-expiratory occlusion technique

Bothend-inspiratory (EIO) and end-expiratory (EEO) occlusions have beenused to measure the strength of the Hering-Breuer inflation reflex(HBIR) in infants. The purpose of this study was to compare bothtechniques in anesthetized infants. In each infant, HBIR activity wascalculated as the relative prolongation of expiratory and inspiratorytime during EIO and EEO, respectively. Respiratory drive was assessedfrom the change in airway pressure during inspiratory effort againstthe occlusion, both at a fixed time interval of 100 ms(P_0.1) and a fixed proportion(10%) of the occluded inspiratory time(P_10%). Twenty-two infants [age 14.3 ± 6.4 (SD) mo] were studied. No HBIR activitywas present during EIO [11.8 ± 15.9 (SD) %]. Bycontrast, there was significant, albeit weak, reflex activity duringEEO [HBIR: 27.2 ± 17.4%]. A strong HBIR (up to 310%)was elicited in six of seven infants in whom EIO was repeated afterlung inflation. P_0.1 was similar during both types of occlusions, whereas mean ± SDP_10% was lower during EEO thanduring EIO: 0.198 ± 0.09 vs. 0.367 ± 0.15 kPa, respectively(P < 0.01). These data suggest adifference in the central integration of stretch receptor activity ininfants during anesthesia compared with during sleep.