Airway Pressure and End Expiratory Lung Volumes (EELV) Delivered by Non-Invasive High Frequency Oscillatory Ventilation Compared to a Prototype High Frequency Nasal Cannula Device in Neonates

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Background: Non-invasive ventilation (NIV) is now the preferred mode of respiratory support for many neonates. Non-invasive high frequency oscillatory ventilation (nHFOV) has been used when CPAP or conventional NIV failed. nHFOV combines advantages of HFV and CPAP, it is thought to be better at removing carbon dioxide (CO2) and maintain functional residual capacity. We previously showed that a prototype High Frequency Nasal Cannula device (HIFI-NC) removes CO2 more efficiently and delivers a higher tracheal pressure (TP) compared to regular HFNC or bubble CPAP. To date there are no data regarding TP and VT delivered via nHFOV in neonates
To compare TP and EELV delivered by nHFOV compared to HIFI-NC via a 3-D prototype neonatal nasal airway using a lung simulator
A neonatal lung model was programmed into an ASL 5000 lung simulator (version 3.5, IngMar Medical) to represent a 1-3kg neonate with moderate to severely affected lungs: compliance 0.5 mL/cm H2O; resistance,150 cm H2O/L/s; simulated muscle pressure minus 5cm H2O (active model). A nose fixture created using a 3-D printer attached to a standard 22-15-mm adapter and connected to ASL 5000 to simulate a neonatal nasal passage. The model was subjected to nHFOV via a size 3.0 nasal cannula using frequency of 8 Hz, inspiratory time 33%, amplitude 10cm and varying mean airway pressure of 5,6,7,8,9 and 10cmH20. The model was then subjected to HIFI-NC at flows of 5, 6,7,8,9 and 10L/min. TP and EELV were continuously measured from the lung simulator and exported to a spreadsheet for analysis. Each experimental maneuver was replicated 3 times and the values for each study tabulated. Data were analyzed using paired t-test and p <0.05 was considered significant
The results for each experiment were highly reproducible. The measured TP and EELV increased with increasing MAP and flow but was significantly lower with nHFOV compared to HIFI-NC at every measurement setting.
In this simulated lung model, a measurable TP and EELV was delivered by nHFOV although it is much lower than HIFI-NC. Both TP and EELV were higher with increasing MAP and flow. The measured TP were significantly lower than the set ventilator pressures because of the leak via the nasal interface. Because HIFI-NC can deliver higher TP and EELV, this simpler device has the potential to provide better non-invasive support compared to nHFOV and may translate into clinical benefits

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MedStar Georgetown University Hospital
MedStar Washington Hospital Center

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