A humidifier in the invasive mode during noninvasive respiratory support could increase condensation and thereby impair airway patency

Flink, Rutger C.; Kaam, Anton H. van; Jongh, Frans de

doi:10.1111/apa.14383

Cited by 7 publications

(4 citation statements)

References 11 publications

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“…Numerous factors influence optimal humidification in preterm infants during non‐invasive ventilation, as stated by de Klerk et al. in their response to our paper in Acta Paediatrica . Environmental determinants are of particular interest when patients are placed under a radiant heater, but the respiratory circuit temperature probes are frequently placed close to the patient and inside the incubator, with its preset temperature and relative humidity.…”

Section: The Theoretical Impact Of Leaks On Temperature Relative Hummentioning

confidence: 87%

Reply from the authors: Additional factors to consider with regard to condensation in bench studies

2018

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Section: The Theoretical Impact Of Leaks On Temperature Relative Hummentioning

confidence: 87%

Reply from the authors: Additional factors to consider with regard to condensation in bench studies

2018

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“…Analysis of some data from adults suggests that the minimum absolute humidity is 15 mg H 2 O/L 43 ; whereas a heated humidifier commonly used to support neonates with bubble CPAP in high resource settings generates 23-27 mg H 2 O/L. 42 The tested bubble CPAP system sources humidity both from the humidity present in entrained ambient air and from a passive bubble humidifier. Therefore, the amount of humidity generated by the device depends on the temperature and humidity of the environment.…”

Section: Discussionmentioning

confidence: 99%

“…Many CPAP systems include an active heated humidifier, but these have drawbacks, including that they can cause condensation to accumulate in the circuit. Condensation may increase the infection risk and has been associated with nasal obstruction 42 and unintended increases in pressure levels. 32 There are no defined standards for optimal temperature and humidity levels of CPAP breathing gases.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of a Bubble CPAP System for Low Resource Settings

Dundek

Ng²,

Brazil³

et al. 2021

Respir Care

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BACKGROUND: Despite its established safety, efficacy, and relative simplicity, CPAP treatment is not widely available for newborns and infants in low-and middle-income settings. A novel bubble CPAP system was designed to address the gaps in quality and accessibility of existing CPAP systems by providing blended, humidified, and pressurized gases without the need for electricity, compressed air, or manual power. This was the first study that tested the performance of the system with a simulated patient model. METHODS: In a spontaneously breathing 3dimensional printed nasal airway model of a preterm neonate, CPAP performance was assessed based on delivered pressure, oxygen level, and humidity at different settings. RESULTS: Preliminary device performance characteristics were within 5% among 3 separate devices. Performance testing showed accurate control of CPAP and oxygen concentration at all settings with the bubble CPAP system. Lung model pressure and oxygen concentration were shown to stay within 60.5 cm H 2 O and 64% of full scale of the device settings, respectively, with relative humidity > 80%. CONCLUSIONS: Performance testing of the bubble CPAP system demonstrated accurate control of CPAP and oxygen concentration with humidity levels suitable for premature newborns on noninvasive support.

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“…As is well known in intubated patients where upper airways are bypassed with an endotracheal tube, a heated and humidified gas source is required when applying mechanical ventilation. Heated humidity with an active humidifier is commonly applied in neonates on nasal CPAP in resourced settings, but this often results in excessive accumulation and aspiration of condensed water vapor in the hoses and prongs [35]. In sub-Saharan Africa approximately 4-10% of neonatal units that apply noninvasive support can provide humidified blended oxygen with medical air to all infants [36].…”

Section: Humidificationmentioning

confidence: 99%

Evaluation of a Novel Dry Powder Surfactant Aerosol Delivery System for Use in Premature Infants Supported with Bubble CPAP

DiBlasi,

Crandall,

Engberg

et al. 2023

Pharmaceutics

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Aerosolized lung surfactant therapy during nasal continuous positive airway pressure (CPAP) support avoids intubation but is highly complex, with reported poor nebulizer efficiency and low pulmonary deposition. The study objective was to evaluate particle size, operational compatibility, and drug delivery efficiency with various nasal CPAP interfaces and gas humidity levels of a synthetic dry powder (DP) surfactant aerosol delivered by a low-flow aerosol chamber (LFAC) inhaler combined with bubble nasal CPAP (bCPAP). A particle impactor characterized DP surfactant aerosol particle size. Lung pressures and volumes were measured in a preterm infant nasal airway and lung model using LFAC flow injection into the bCPAP system with different nasal prongs. The LFAC was combined with bCPAP and a non-heated passover humidifier. DP surfactant mass deposition within the nasal airway and lung was quantified for different interfaces. Finally, surfactant aerosol therapy was investigated using select interfaces and bCPAP gas humidification by active heating. Surfactant aerosol particle size was 3.68 µm. Lung pressures and volumes were within an acceptable range for lung protection with LFAC actuation and bCPAP. Aerosol delivery of DP surfactant resulted in variable nasal airway (0–20%) and lung (0–40%) deposition. DP lung surfactant aerosols agglomerated in the prongs and nasal airways with significant reductions in lung delivery during active humidification of bCPAP gas. Our findings show high-efficiency delivery of small, synthetic DP surfactant particles without increasing the potential risk for lung injury during concurrent aerosol delivery and bCPAP with passive humidification. Specialized prongs adapted to minimize extrapulmonary aerosol losses and nasal deposition showed the greatest lung deposition. The use of heated, humidified bCPAP gases compromised drug delivery and safety. Safety and efficacy of DP aerosol delivery in preterm infants supported with bCPAP requires more research.

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A humidifier in the invasive mode during noninvasive respiratory support could increase condensation and thereby impair airway patency

Abstract: The absolute humidity delivered by the humidifier in invasive mode could be associated with increased condensation, which has been associated with airway impairment.

Cited by 7 publications

References 11 publications

Reply from the authors: Additional factors to consider with regard to condensation in bench studies

Reply from the authors: Additional factors to consider with regard to condensation in bench studies

Evaluation of a Bubble CPAP System for Low Resource Settings

Evaluation of a Novel Dry Powder Surfactant Aerosol Delivery System for Use in Premature Infants Supported with Bubble CPAP

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