Nasal versus face mask for multiple-breath washout technique in preterm infants

The large dead space associated with face masks might impede the accuracy and feasibility of multiple-breath washout (MBW) measurements in small infants. We asked if a low dead space nasal mask would provide measurements of resting lung volume and ventilation inhomogeneity comparable to those obtained with a face mask, when using the MBW technique. Unsedated preterm infants breathing without mechanical assistance and weighing between 1.50 and 2.49 kg were studied. Paired MBW tests with nasal and face masks were obtained using sulphur hexafluoride (SF(6)) as the tracer gas. The order of mask application was quasi-randomized. Bland-Altman method and intraclass correlation coefficient were used to analyze outcomes. Measurements were obtained in 20 infants with a mean (SD) postmenstrual age of 36 (1.4) w and a test weight of 2.0 (0.3) kg. The mean difference (95% CI) for nasal vs. face mask was -3.2 breaths/min (-6.2, -0.1 breaths/min) for respiratory rate, -1.0 ml/kg (-2.3, 0.3 ml/kg) for lung volume, 0.6 (0.1, 1.1) for lung clearance index, 0.2 (0.1, 0.3) for first to zeroeth moment ratio and 1.33 (0.6, 2.4) for second to zeroeth moment ratio. Paired measurements of lung volume showed acceptable agreement and good correlation, but there was poor agreement and poor correlation between indices of ventilation inhomogeneity obtained with the two masks. Functional dead space of the nasal mask was similar to that of the face mask despite its smaller water displacement volume. During MBW in infants below 2.5 kg body weight, a nasal mask results in comparable lung volume measurements. Indices of ventilation inhomogeneity may not be directly comparable using masks with different dead space.