PEDIATRICS Vol. 107 No. 2 February 2001, pp. 304-308
Lung Recruitment and Breathing Pattern During Variable Versus Continuous Flow Nasal Continuous Positive Airway Pressure in Premature Infants: An Evaluation of Three Devices
Received Jan 31, 2000; accepted May 30, 2000.
,
From the * Robert Wood Johnson Medical School at Camden and the
Department of Pediatrics, Division of Neonatology, the Children's
Regional Hospital at Cooper Hospital/University Medical Center, Camden,
New Jersey; American College of Physicians and American Society of
Internal Medicine, Philadelphia, Pennsylvania; and § Mercy Children's
Hospital at St Vincent's Mercy Medical Center and the Department of
Pediatrics, Medical College of Ohio, Toledo, Ohio.
Objective. To determine whether lung volume changes and breathing pattern parameters differ among 3 devices for delivery of nasal continuous positive airway pressure (CPAP) in premature infants.
Methods. Thirty-two premature infants receiving nasal CPAP
for apnea or mild respiratory distress were enrolled. Birth weight was
(mean ± standard deviation) 1081 ± 316 g, gestational
age 29 ± 2 weeks, age at study 13 ± 12 days, and fraction
of inspired oxygen (FIO2) at study .29 ± .1. Three devices, applied in random order, were studied in each
infant: continuous flow nasal CPAP via CPAP prongs, continuous flow
nasal CPAP via modified nasal cannula, and variable flow nasal CPAP.
After lung recruitment to standardize volume history, changes in lung
volume (
VL) were assessed at nasal CPAP of 8, 6, 4, and
0 cm H2O using calibrated direct current-coupled respiratory inductance plethysmography.
Results. VL was significantly greater
overall with the variable flow device compared with both the nasal
cannula and CPAP prongs. However, VL was not different
between the cannula and the prongs. Respiratory rate, tidal volume,
thoraco-abdominal asynchrony, and FIO2 were
greater with the modified cannula than for either of the other 2 devices.
Conclusion. Compared with 2 continuous flow devices, the variable flow nasal CPAP device leads to greater lung recruitment. Although a nasal cannula is able to recruit lung volume, it does so at the cost of increased respiratory effort and FIO2. Key words: nasal CPAP, lung volume changes, preterm infants, respiratory inductance plethysmography.
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