Published online December 31, 2007
PEDIATRICS Vol. 121 No. 1 January 2008, pp. 82-88 (doi:10.1542/peds.2007-0957)
This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when eLetters are posted
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow E-mail this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in Web of Science
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My File Cabinet
Right arrow Download to citation manager
Right arrowRequest Permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via CrossRef
Right arrow Citing Articles via Web of Science (5)
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Kubicka, Z. J.
Right arrow Articles by Darnall, R. A.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Kubicka, Z. J.
Right arrow Articles by Darnall, R. A.
Related Collections
Right arrow Premature & Newborn
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us   Add to Digg   Add to Facebook   Add to Reddit   Add to Technorati   Add to Twitter  
What's this?

ARTICLE

Heated, Humidified High-Flow Nasal Cannula Therapy: Yet Another Way to Deliver Continuous Positive Airway Pressure?

Zuzanna J. Kubicka, MDa, Joseph Limauro, RRTb and Robert A. Darnall, MDa,c

a Departments of Pediatrics
b Respiratory Therapy
c Physiology, Dartmouth Medical School and Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire

OBJECTIVE. The goal was to estimate the level of delivered continuous positive airway pressure by measuring oral cavity pressure with the mouth closed in infants of various weights and ages treated with heated, humidified high-flow nasal cannula at flow rates of 1–5 L/minute. We hypothesized that clinically relevant levels of continuous positive airway pressure would not be achieved if a nasal leak is maintained.

METHODS. After performing bench measurements and demonstrating that oral cavity pressure closely approximated levels of traditionally applied nasal continuous positive airway pressure, we successfully measured oral cavity pressure during heated, humidified, high-flow nasal cannula treatment in 27 infants. Small (outer diameter: 0.2 cm) cannulae were used for all infants, and flow rates were left as ordered by providers.

RESULTS. Bench measurements showed that, for any given leak size, there was a nearly linear relationship between flow rate and pressure. The highest pressure achieved was 4.5 cmH2O (flow rate: 8 L/minute; leak: 3 mm). In our study infants (postmenstrual age: 29.1–44.7 weeks; weight: 835–3735 g; flow rate: 1–5 L/minute), no pressure was generated with the mouth open at any flow rate. With the mouth closed, the oral cavity pressure was related to both flow rate and weight. For infants of ≤1500 g, there was a linear relationship between flow rate and oral cavity pressure.

CONCLUSIONS. Oral cavity pressure can estimate the level of continuous positive airway pressure. Continuous positive airway pressure generated with heated, humidified, high-flow nasal cannula treatment depends on the flow rate and weight. Only in the smallest infants with the highest flow rates, with the mouth fully closed, can clinically significant but unpredictable levels of continuous positive airway pressure be achieved. We conclude that heated, humidified high-flow nasal cannula should not be used as a replacement for delivering continuous positive airway pressure.

Key Words: oxygen delivery • high-flow nasal cannula • continuous positive airway pressure • infant

Abbreviations: HHHFNC—heated, humidified, high-flow, nasal cannula • CPAP—continuous positive airway pressure • OD—outer diameter • NCPAP—nasal continuous positive airway pressure

Accepted Jul 27, 2007.


Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us   Add to Digg Digg   Add to Facebook Facebook   Add to Reddit Reddit   Add to Technorati Technorati   Add to Twitter Twitter    What's this?


This article has been cited by other articles:


Home page
 Br J AnaesthHome page
R. Parke, S. McGuinness, and M. Eccleston
Nasal high-flow therapy delivers low level positive airway pressure
Br. J. Anaesth., October 20, 2009; (2009) aep280v1.
[Abstract] [Full Text] [PDF]

Home page
 J Intensive Care MedHome page
T. Spentzas, M. Minarik, A. B. Patters, B. Vinson, and G. Stidham
Children With Respiratory Distress Treated With High-Flow Nasal Cannula
J Intensive Care Med, September 1, 2009; 24(5): 323 - 328.
[Abstract] [PDF]

Home page
 PediatricsHome page
B. A. BouAram and C. J. Fernandes
Heated, Humidified High-Flow Nasal Cannula Therapy: Yet Another Way to Deliver Continuous Positive Airway Pressure?
Pediatrics, July 1, 2008; 122(1): 218 - 219.
[Full Text] [PDF]

Home page
 PediatricsHome page
Z. Kubicka
Heated, Humidified High-Flow Nasal Cannula Therapy: Yet Another Way to Deliver Continuous Positive Airway Pressure?: In Reply
Pediatrics, July 1, 2008; 122(1): 219 - 219.
[Full Text] [PDF]

Home page
 PediatricsHome page
D. J. Weiner, J. McDonough, M. Perez, J. Evans, W. Fox, A. Hedgman, L. Tyler, and H. B. Panitch
Heated, Humidified High-Flow Nasal Cannula Therapy
Pediatrics, June 1, 2008; 121(6): 1293 - 1294.
[Full Text] [PDF]

Home page
 PediatricsHome page
Z. Kubicka, R. Darnall, and J. Limauro
Heated, Humidified High-Flow Nasal Cannula Therapy: In Reply
Pediatrics, June 1, 2008; 121(6): 1294 - 1294.
[Full Text] [PDF]

Home page
 PediatricsHome page
D. Dilli
Analgesic Properties of Oral Sucrose During Routine Immunizations
Pediatrics, June 1, 2008; 121(6): 1294 - 1295.
[Full Text] [PDF]