Comparison of airway pressures and expired gas washout for nasal high flow versus CPAP in child airway replicas

Abstract Background For children and adults, the standard treatment for obstructive sleep apnea is the delivery of continuous positive airway pressure (CPAP). Though effective, CPAP masks can be uncomfortable to patients, contributing to adherence concerns. Recently, nasal high flow (NHF) therapy ha...

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Autores principales:	Kelvin Duong, Michelle Noga, Joanna E. MacLean, Warren H. Finlay, Andrew R. Martin
Formato:	article
Lenguaje:	EN
Publicado:	BMC 2021
Materias:	Obstructive sleep apnea Continuous positive airway pressure Nasal high flow Nasal cannula Adherence Tracheal pressure Diseases of the respiratory system RC705-779
Acceso en línea:	https://doaj.org/article/5d633c5096d3415c99c4d1e1f7b8c247
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spelling	oai:doaj.org-article:5d633c5096d3415c99c4d1e1f7b8c2472021-11-14T12:31:52ZComparison of airway pressures and expired gas washout for nasal high flow versus CPAP in child airway replicas10.1186/s12931-021-01880-z1465-993Xhttps://doaj.org/article/5d633c5096d3415c99c4d1e1f7b8c2472021-11-01T00:00:00Zhttps://doi.org/10.1186/s12931-021-01880-zhttps://doaj.org/toc/1465-993XAbstract Background For children and adults, the standard treatment for obstructive sleep apnea is the delivery of continuous positive airway pressure (CPAP). Though effective, CPAP masks can be uncomfortable to patients, contributing to adherence concerns. Recently, nasal high flow (NHF) therapy has been investigated as an alternative, especially in CPAP-intolerant children. The present study aimed to compare and contrast the positive airway pressures and expired gas washout generated by NHF versus CPAP in child nasal airway replicas. Methods NHF therapy was investigated at a flow rate of 20 L/min and compared to CPAP at 5 cmH2O and 10 cmH2O for 10 nasal airway replicas, built from computed tomography scans of children aged 4–8 years. NHF was delivered with three different high flow nasal cannula models provided by the same manufacturer, and CPAP was delivered with a sealed nasal mask. Tidal breathing through each replica was imposed using a lung simulator, and airway pressure at the trachea was recorded over time. For expired gas washout measurements, carbon dioxide was injected at the lung simulator, and end-tidal carbon dioxide (EtCO2) was measured at the trachea. Changes in EtCO2 compared to baseline values (no intervention) were assessed. Results NHF therapy generated an average positive end-expiratory pressure (PEEP) of 5.17 ± 2.09 cmH2O (mean ± SD, n = 10), similar to PEEP of 4.95 ± 0.03 cmH2O generated by nominally 5 cmH2O CPAP. Variation in tracheal pressure was higher between airway replicas for NHF compared to CPAP. EtCO2 decreased from baseline during administration of NHF, whereas it increased during CPAP. No statistical difference in tracheal pressure nor EtCO2 was found between the three high flow nasal cannulas. Conclusion In child airway replicas, NHF at 20 L/min generated average PEEP similar to CPAP at 5 cm H2O. Variation in tracheal pressure was higher between airway replicas for NHF than for CPAP. The delivery of NHF yielded expired gas washout, whereas CPAP impeded expired gas washout due to the increased dead space of the sealed mask.Kelvin DuongMichelle NogaJoanna E. MacLeanWarren H. FinlayAndrew R. MartinBMCarticleObstructive sleep apneaContinuous positive airway pressureNasal high flowNasal cannulaAdherenceTracheal pressureDiseases of the respiratory systemRC705-779ENRespiratory Research, Vol 22, Iss 1, Pp 1-13 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Obstructive sleep apnea Continuous positive airway pressure Nasal high flow Nasal cannula Adherence Tracheal pressure Diseases of the respiratory system RC705-779
spellingShingle	Obstructive sleep apnea Continuous positive airway pressure Nasal high flow Nasal cannula Adherence Tracheal pressure Diseases of the respiratory system RC705-779 Kelvin Duong Michelle Noga Joanna E. MacLean Warren H. Finlay Andrew R. Martin Comparison of airway pressures and expired gas washout for nasal high flow versus CPAP in child airway replicas
description	Abstract Background For children and adults, the standard treatment for obstructive sleep apnea is the delivery of continuous positive airway pressure (CPAP). Though effective, CPAP masks can be uncomfortable to patients, contributing to adherence concerns. Recently, nasal high flow (NHF) therapy has been investigated as an alternative, especially in CPAP-intolerant children. The present study aimed to compare and contrast the positive airway pressures and expired gas washout generated by NHF versus CPAP in child nasal airway replicas. Methods NHF therapy was investigated at a flow rate of 20 L/min and compared to CPAP at 5 cmH2O and 10 cmH2O for 10 nasal airway replicas, built from computed tomography scans of children aged 4–8 years. NHF was delivered with three different high flow nasal cannula models provided by the same manufacturer, and CPAP was delivered with a sealed nasal mask. Tidal breathing through each replica was imposed using a lung simulator, and airway pressure at the trachea was recorded over time. For expired gas washout measurements, carbon dioxide was injected at the lung simulator, and end-tidal carbon dioxide (EtCO2) was measured at the trachea. Changes in EtCO2 compared to baseline values (no intervention) were assessed. Results NHF therapy generated an average positive end-expiratory pressure (PEEP) of 5.17 ± 2.09 cmH2O (mean ± SD, n = 10), similar to PEEP of 4.95 ± 0.03 cmH2O generated by nominally 5 cmH2O CPAP. Variation in tracheal pressure was higher between airway replicas for NHF compared to CPAP. EtCO2 decreased from baseline during administration of NHF, whereas it increased during CPAP. No statistical difference in tracheal pressure nor EtCO2 was found between the three high flow nasal cannulas. Conclusion In child airway replicas, NHF at 20 L/min generated average PEEP similar to CPAP at 5 cm H2O. Variation in tracheal pressure was higher between airway replicas for NHF than for CPAP. The delivery of NHF yielded expired gas washout, whereas CPAP impeded expired gas washout due to the increased dead space of the sealed mask.
format	article
author	Kelvin Duong Michelle Noga Joanna E. MacLean Warren H. Finlay Andrew R. Martin
author_facet	Kelvin Duong Michelle Noga Joanna E. MacLean Warren H. Finlay Andrew R. Martin
author_sort	Kelvin Duong
title	Comparison of airway pressures and expired gas washout for nasal high flow versus CPAP in child airway replicas
title_short	Comparison of airway pressures and expired gas washout for nasal high flow versus CPAP in child airway replicas
title_full	Comparison of airway pressures and expired gas washout for nasal high flow versus CPAP in child airway replicas
title_fullStr	Comparison of airway pressures and expired gas washout for nasal high flow versus CPAP in child airway replicas
title_full_unstemmed	Comparison of airway pressures and expired gas washout for nasal high flow versus CPAP in child airway replicas
title_sort	comparison of airway pressures and expired gas washout for nasal high flow versus cpap in child airway replicas
publisher	BMC
publishDate	2021
url	https://doaj.org/article/5d633c5096d3415c99c4d1e1f7b8c247
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_version_	1718429169387307008

Comparison of airway pressures and expired gas washout for nasal high flow versus CPAP in child airway replicas

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