High Flow Through a Nasal Cannula and CPAP Effect in a Simulated Infant Model
Teresa A Volsko MHHS RRT FAARC, Kathy Fedor RRT-NPS, Jason Amadei RRT, and Robert L Chatburn MHHS RRT-NPS FAARC BACKGROUND: Limited data are available to describe the CPAP effects that can be expected when using high flow with a traditional nasal cannula. OBJECTIVE: To describe the relationship between the pressure generated at the airway opening and flow through a nasal cannula using a simulated infant model. We hypothesized that positive pressure generated by a standard cannula at flows > 2
... nula at flows > 2 L/min would be minimal and clinically unimportant. METHODS: Nares were simulated with holes drilled in a plastic fixture. A nares template for CPAP prongs served as a sizing template for the holes. Small, medium, and large nares fixtures were constructed and connected to a lung simulator that simulated spontaneous breathing. Respiratory muscle pressure was simulated by setting a waveform and adjusting the amplitude to deliver a range of tidal volumes (V T ) from 3 mL to 12 mL. Lung compliance and resistance were set at 0.5 mL/cm H 2 O and 125 cm H 2 O/L/s, respectively. Nasal cannulas were inserted in the model nares. We assured that the prong occlusion of the nares did not exceed 50%. Cannula flow was adjusted from 2-6 L/min in 1-L/min increments. Data were averaged over 20 breaths. Mean airway pressure and percent change in V T were recorded. RESULTS: The greatest effect on V T (mean ؎ SD 0.16 ؎ 0.10 mL) and pressure change (mean ؎ SD 0.7 ؎ 0.5 cm H 2 O) occurred with the premature cannula. The least effect on pressure (mean ؎ SD 0.3 ؎ 0.22 cm H 2 O) and V T change (mean ؎ SD 0.01 ؎ 0.02 mL) occurred with the infant cannula. CONCLUSIONS: Clinically important pressures were not generated by high flows with a standard nasal cannula. The differences in spontaneous V T across all flows were negligible.