Work of breathing during CPAP and heated humidified high-flow nasal cannula

Shetty, Sandeep; Hickey, Ann; Rafferty, Gerrard F.; Peacock, Janet L.; Greenough, Anne

doi:10.1136/archdischild-2015-309310

Cited by 30 publications

(26 citation statements)

References 11 publications

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“…Our study suggests that this pressure-to-flow ratio results in a similar level of support during nCPAP and HFNC. This finding is in line with previous crossover studies assessing the effect of HFNC and nCPAP on work of breathing measured with an oesophageal balloon 12 14 15. These studies reported no differences in work of breathing when comparing different flow rates (2–8 L/min) during HFNC with nCPAP levels of 5–6 cmH 2 O.…”

Section: Discussionsupporting

confidence: 91%

“…Most studies have investigated the association between flow rate and intrapharyngeal or transoesophageal pressure, showing conflicting results 12–14. The effect of HFNC on work of breathing has been studied using an oesophageal balloon or pressure catheter and no differences between HFNC and nCPAP were reported 12 14 15. However, most of these studies included a relatively small number of infants and measured work of breathing only once for a short period of time (<15 min).…”

Section: Introductionmentioning

confidence: 99%

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Electrical activity of the diaphragm during nCPAP and high flow nasal cannula

Waal

Hutten

Kraaijenga

et al. 2017

Arch Dis Child Fetal Neonatal Ed

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Section: Discussionsupporting

confidence: 91%

Section: Introductionmentioning

confidence: 99%

Electrical activity of the diaphragm during nCPAP and high flow nasal cannula

Waal

Hutten

Kraaijenga

et al. 2017

Arch Dis Child Fetal Neonatal Ed

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show abstract

“…Several randomized crossover studies have attempted to investigate the effects of NCPAP and HFNC on physiological parameters. These studies revealed no differences in heart and respiratory rate, FiO 2 levels, oxygen saturation, work of breathing, thoraco‐abdominal asynchrony, or electrical activity of the diaphragm . However, the studies included more mature infants clinically stable on NCPAP for several days at the time of the measurements.…”

Section: Discussionmentioning

confidence: 99%

The effects of nasal continuous positive airway pressure and high flow nasal cannula on heart rate variability in extremely preterm infants after extubation: A randomized crossover trial

Latremouille

Shalish

Kanbar³

et al. 2019

Pediatric Pulmonology

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Background NCPAP and High flow nasal cannula (HFNC) are common modes of non‐invasive respiratory support used after extubation. Heart rate variability (HRV) has been demonstrated as a marker of well‐being in neonates and differences in HRV were described in preterm infants receiving respiratory care. The objective was to investigate the effects of NCPAP and HFNC on HRV after extubation. Methods Randomized crossover trial in infants with birth weight (BW) ≤1250 g after undergoing their first elective extubation. ECG recordings were performed during 45 min while on HFNC and nasal continuous positive airway pressure (NCPAP). Time domain, non‐linear, and frequency domain parameters were calculated and compared during HFNC and NCPAP using paired nonparametric tests. A secondary analysis was performed in the subgroup of infants that were successfully extubated. Results Thirty infants with median [range] gestational age of 27 weeks [24.1‐29.3] and BW of 930 g [610‐1220] were studied at 5 days [1‐39] of age. No differences in HRV parameters were observed between HFNC and NCPAP. In the secondary analysis, infants successfully extubated (n = 27) had a significantly higher HRV during HFNC for some time domain parameters. For instance, the standard deviation of the RR intervals (SDRR) was more likely to be higher during HFNC compared to NCPAP (HFNC: 18/27 vs NCPAP: 9/27, P = 0.017) . Conclusion During the first hours after extubation, no differences in HRV were detected between HFNC and NCPAP in the overall cohort. However, a significantly higher HRV was noted during HFNC in the subgroup of infants successfully extubated.

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“…Despite its increasing popularity, data on the physiological effects of NHF remains limited. A number of studies have investigated the potential continuous distending pressure that NHF may deliver and its effect on work of breathing (WOB) …”

Section: Introductionmentioning

confidence: 99%

Nasal high flow in preterm infants: A dose‐finding study

Hough

Shearman

Jardine

et al. 2019

Pediatric Pulmonology

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Objective To investigate the relationship between applied flows of nasal high flow (NHF) and physiological outcomes and work of breathing (WOB), to identify an optimal delivery flow which results in reduced WOB in preterm infants. Design A prospective observational clinical study with randomly applied NHF rates. Patients and Setting Preterm infants within 72 hours of commencement of NHF respiratory support. Interventions Infants were initially placed on 8 L/min of NHF and flows of 2, 4, and 6 L/min were then applied in random order. Measurements and Results WOB was measured using transcutaneous electromyography and respiratory inductance plethysmography. Physiological variables were also recorded. Measurements taken 10 minutes after each flow change were compared with 8 L/min. Sixteen infants with a median gestational age of 28 (range 24‐31) weeks and postnatal age of 14 (2‐55) days were included in the study. The median flow rate before the study was 6 (4‐8) L/min and a fraction of inspired oxygen (FiO2) was 0.21 (0.21‐0.26). Changes in flow resulted in changes in activity in the front diaphragm (P = .027) and intercostals (P = .034). The electrical activity of the front diaphragm at 8 L/min was significantly lower than that at 2 L/min (P = .016). Respiratory rate was lowest at 6 L/min (P = .002) and SpO2/FiO2 was highest at 8 L/min (P < .04). Conclusion In preterm infants, changes in WOB resulting from randomly applied levels of NHF can be demonstrated by measuring the electrical activity of the diaphragm and intercostal muscles with transcutaneous electromyography. In combination with physiological measurements, the similarities in electrical activity between 4, 6, and 8 L/min suggest that these three flows may be equally as effective.

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Work of breathing during CPAP and heated humidified high-flow nasal cannula

Abstract: In infants with evolving or established BPD, CPAP compared with HHFNC offered no significant advantage with regard to the WOB, degree of asynchrony or oxygen saturation.

Cited by 30 publications

References 11 publications

Electrical activity of the diaphragm during nCPAP and high flow nasal cannula

Electrical activity of the diaphragm during nCPAP and high flow nasal cannula

The effects of nasal continuous positive airway pressure and high flow nasal cannula on heart rate variability in extremely preterm infants after extubation: A randomized crossover trial

Nasal high flow in preterm infants: A dose‐finding study

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