Upper airway pressure distribution during nasal high-flow therapy. (June 2022)

• Record Type: Journal Article
• Authors: Hebbink, Rutger H.J.; Duiverman, Marieke L.; Wijkstra, Peter J.; Hagmeijer, Rob
• Is Part Of: Medical engineering & physics. Volume 104(2022)
• Publication Date: 2022-06
• Subjects: Nasal high-flow therapy -- Pressure distribution -- Positive end-expiratory pressure -- Dead space washout -- Upper airway; Biomedical engineering -- Periodicals; Biomedical Engineering -- Periodicals; Physics -- Periodicals; Génie biomédical -- Périodiques; Biomedical engineering; Electronic journals; Periodicals; 610.28
• DOI: 10.1016/j.medengphy.2022.103805
• Languages: English
• ISSNs: 1350-4533

Abstract

Highlights: The upper airway pressure distribution during nasal high-flow therapy is measured. The jet penetrates into or slightly beyond the nasal cavity at end-expiration. Jet penetration hardly depends on cannula size or flow rate. Positive end-expiratory pressure is roughly proportional to the flow rate squared. Abstract: Two working mechanisms of Nasal High-Flow Therapy (NHFT) are washout of anatomical dead space and provision of positive end-expiratory pressure (PEEP). The extent of both mechanisms depends on the respiration aerodynamics and the corresponding pressure distribution: at end-expiration the onset of uniform pressure indicates the jet penetration length, and the level of the uniform pressure is the PEEP. The clinical problem is that adequate measurements in patients are presently impossible. In this study, the respiratory pressure distribution is therefore measured in 3D-printed anatomically correct upper-airway models of an adult and an infant. Assuming that elastic fluctuations in airway anatomy are sufficiently small, the aerodynamics in these rigid models will be very similar to the aerodynamics in patients. It appears that, at end-expiration, the jet penetrates into or slightly beyond the nasal cavity, hardly depending on cannula size or NHFT flow rate. PEEP is approximately proportional to the square of the flow rate: it can be doubled by increasing the flow rate by 40%. In the adult model, PEEP is accurately predicted by the dynamic pressure at the prong-exits, but in the infant model this method fails. During respiration, large pressure fluctuations occur when the cannula is relatively large compared to the nostrils.