Work of breathing during CPAP and heated humidified high-flow nasal cannula. Issue 5 (14th January 2016)

• Record Type: Journal Article
• Authors: Shetty, Sandeep; Hickey, Ann; Rafferty, Gerrard F; Peacock, Janet L; Greenough, Anne
• Is Part Of: Archives of disease in childhood. Volume 101:Issue 5(2016)
• Page Start: F404
• Page End: F407
• Publication Date: 2016-01-14
• Subjects: high flow nasal cannula -- continuous positive airway pressure -- bronchopulmonary dysplasia -- work of breathing; Infants -- Diseases -- Periodicals; Newborn infants -- Diseases -- Periodicals; Fetus -- Diseases -- Periodicals; 618.920105
• DOI: 10.1136/archdischild-2015-309310
• Languages: English
• ISSNs: 1359-2998

Abstract

Abstract : Objective: To determine whether continuous positive airway pressure (CPAP) compared with heated humidified, high-flow nasal cannula (HHFNC) in infants with evolving or established bronchopulmonary dysplasia (BPD) reduced the work of breathing (WOB) and thoracoabdominal asynchrony (TAA) and improved oxygen saturation (SaO2 ). Design: Randomised crossover study. Setting: Tertiary neonatal unit. Patients: 20 infants (median gestational age of 27.6 weeks (range 24.6–31.9 weeks)) were studied at a median postnatal age of 30.9 weeks (range 28.1–39.1 weeks). Interventions: Infants were studied on 2 consecutive days. On the first study day, they were randomised to either CPAP or HHFNC each for 2 h, the order being reversed on the second day. Main outcome measures: The WOB was assessed by measuring the pressure time product of the diaphragm (PTPdi). PTPdi, TAA and SaO2 were assessed during the final 5 min of each 2 h period and the results on the two study days were meaned. Results: There were no significant differences in the results on CPAP versus HHFNC: mean PTPdi 226 (range 126–294) versus 224 cm H2 O/s/min (95% CI for difference: −27 to 22; p=0.85) (range 170–318) (p=0.82), mean TAA 13.4° (range 4.51°–23.32°) versus 14.01° (range 4.25°–23.86°) (95% CI for difference: −3.9 to 2.8: p=0.73) (p=0.63) and mean SaO2 95% (range 93%–100%) versus 95% (94%–99%), (95% CI for difference −1.8 to 0.5; p=0.25) (p=0.45). Conclusion: 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.