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

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 i...

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Autores principales: Duong, Kelvin, Noga, Michelle, MacLean, Joanna E., Finlay, Warren H., Martin, Andrew R.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8579677/
https://www.ncbi.nlm.nih.gov/pubmed/34758818
http://dx.doi.org/10.1186/s12931-021-01880-z
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author Duong, Kelvin
Noga, Michelle
MacLean, Joanna E.
Finlay, Warren H.
Martin, Andrew R.
author_facet Duong, Kelvin
Noga, Michelle
MacLean, Joanna E.
Finlay, Warren H.
Martin, Andrew R.
author_sort Duong, Kelvin
collection PubMed
description 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 cmH(2)O and 10 cmH(2)O 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 (EtCO(2)) was measured at the trachea. Changes in EtCO(2) compared to baseline values (no intervention) were assessed. RESULTS: NHF therapy generated an average positive end-expiratory pressure (PEEP) of 5.17 ± 2.09 cmH(2)O (mean ± SD, n = 10), similar to PEEP of 4.95 ± 0.03 cmH(2)O generated by nominally 5 cmH(2)O CPAP. Variation in tracheal pressure was higher between airway replicas for NHF compared to CPAP. EtCO(2) decreased from baseline during administration of NHF, whereas it increased during CPAP. No statistical difference in tracheal pressure nor EtCO(2) 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 H(2)O. 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. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12931-021-01880-z.
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spelling pubmed-85796772021-11-10 Comparison of airway pressures and expired gas washout for nasal high flow versus CPAP in child airway replicas Duong, Kelvin Noga, Michelle MacLean, Joanna E. Finlay, Warren H. Martin, Andrew R. Respir Res Research 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 cmH(2)O and 10 cmH(2)O 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 (EtCO(2)) was measured at the trachea. Changes in EtCO(2) compared to baseline values (no intervention) were assessed. RESULTS: NHF therapy generated an average positive end-expiratory pressure (PEEP) of 5.17 ± 2.09 cmH(2)O (mean ± SD, n = 10), similar to PEEP of 4.95 ± 0.03 cmH(2)O generated by nominally 5 cmH(2)O CPAP. Variation in tracheal pressure was higher between airway replicas for NHF compared to CPAP. EtCO(2) decreased from baseline during administration of NHF, whereas it increased during CPAP. No statistical difference in tracheal pressure nor EtCO(2) 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 H(2)O. 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. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12931-021-01880-z. BioMed Central 2021-11-10 2021 /pmc/articles/PMC8579677/ /pubmed/34758818 http://dx.doi.org/10.1186/s12931-021-01880-z Text en © The Author(s) 2021 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research
Duong, Kelvin
Noga, Michelle
MacLean, Joanna E.
Finlay, Warren H.
Martin, Andrew R.
Comparison of airway pressures and expired gas washout for nasal high flow versus CPAP in child airway replicas
title 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_short 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
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8579677/
https://www.ncbi.nlm.nih.gov/pubmed/34758818
http://dx.doi.org/10.1186/s12931-021-01880-z
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