Effect of High-Flow Nasal Cannula on Expiratory Pressure and Ventilation in Infant, Pediatric, and Adult Models

• Published in: Respiratory care 2018-02, Vol.63 (2), p.147-157
• Main Authors: Nielsen, Katie R, Ellington, Laura E, Gray, Alan J, Stanberry, Larissa I, Smith, Lincoln S, DiBlasi, Robert M
• Format: Article
• Language: English
• Subjects: Analysis; Care and treatment; Health aspects; Pediatrics; Premature infants; Respiratory insufficiency; Ventilation
• ISSN: 0020-1324; 1943-3654
• DOI: 10.4187/respcare.05728

Heated and humidified high-flow nasal cannula (HFNC) is a widely used form of respiratory support; however, data regarding optimal flows for a given patient size or disease state are lacking. A comprehensive study of the physiologic effects of HFNC is needed to better understand the mechanisms of action. The objective of the current study was to quantify the effect of HFNC settings in age-specific, anatomically correct nasal airways and spontaneously breathing lung models. We hypothesized that there is an effect of flow on pressure and ventilation. Three-dimensionally printed upper airway models of a preterm neonate, term neonate, toddler, small child, and adult were affixed to the ASL 5000 test lung to simulate spontaneous breathing with age-appropriate normal ventilation parameters. CO was introduced to simulate profound hypercapneic respiratory failure with an end-tidal partial pressure of carbon dioxide (P ) of 90 ± 1 mm Hg. Two commercially available HFNC systems were applied to the airway models, and PEEP, inspired CO , and exhaled CO (P ) were recorded for 6 min across a range of flow. Increasing HFNC flow provided a non-linear increase in PEEP in closed-mouth models, with maximum tested flows generating 6 cm H O in the preterm neonate to 20 cm H O in the small child. Importantly, PEEP decreased by approximately 50% in open-mouth models. Increasing HFNC flow improved expiratory CO elimination to a certain point, above which continued increases in flow had minimal additional effect. This change point ranged from 4 L/min in the preterm neonate to 10 L/min in the small child. These findings may help clinicians understand the effects of HFNC at different settings and may inform management guidelines for patients with respiratory failure.