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Work of breathing during CPAP and heated humidified high-flow nasal cannula
Sandeep Shetty1, Ann Hickey2, Gerrard F Rafferty3
1Neonatal Intensive Care Centre, King's College Hospital, London, UK Division of Asthma, Allergy and Lung Biology, MRC Centre for Allergic Mechanisms in Asthma, King's College London, London, UK.
Insights
Continuous positive airway pressure (CPAP) and heated humidified, high-flow nasal cannula (HHFNC) showed no significant differences in reducing work of breathing or improving oxygen saturation in infants with bronchopulmonary dysplasia. Both methods were equally effective.
Area of Science:
- Neonatal respiratory support
- Pediatric pulmonology
- Infant respiratory distress
Background:
- Bronchopulmonary dysplasia (BPD) is a chronic lung disease in preterm infants.
- Infants with BPD often require respiratory support to manage work of breathing (WOB) and oxygenation.
- Continuous positive airway pressure (CPAP) and heated humidified, high-flow nasal cannula (HHFNC) are common non-invasive respiratory support methods.
Purpose of the Study:
- To compare the efficacy of CPAP versus HHFNC in infants with evolving or established BPD.
- To assess the impact of CPAP and HHFNC on work of breathing (WOB) and thoracoabdominal asynchrony (TAA).
- To evaluate the effect of CPAP and HHFNC on oxygen saturation (SaO2).
Main Methods:
- A randomized crossover study design was employed.
- Twenty infants with BPD were studied in a tertiary neonatal unit.
- Infants received both CPAP and HHFNC for 2-hour periods on consecutive days.
Main Results:
- No significant differences were observed between CPAP and HHFNC in terms of mean PTPdi (work of breathing).
- Thoracoabdominal asynchrony (TAA) showed no significant difference between the two respiratory support methods.
- Oxygen saturation (SaO2) levels were comparable between CPAP and HHFNC groups.
Conclusions:
- CPAP and HHFNC provide similar benefits for infants with BPD regarding WOB, TAA, and SaO2.
- Neither CPAP nor HHFNC demonstrated a significant advantage over the other in this patient population.
- The choice between CPAP and HHFNC may depend on other clinical factors or provider preference.
Objective:
To determine whether continuous positive airway pressure (CPAP) compared with heated humidified, high-flow nasal cannula (HHFNC) in infants with evolving or established bronchopulmonary dysplasia (BPD) reduced the work of breathing (WOB) and thoracoabdominal asynchrony (TAA) and improved oxygen saturation (SaO2).
Design:
Randomised crossover study.
Setting:
Tertiary neonatal unit.
Patients:
20 infants (median gestational age of 27.6 weeks (range 24.6-31.9 weeks)) were studied at a median postnatal age of 30.9 weeks (range 28.1-39.1 weeks).
Interventions:
Infants were studied on 2 consecutive days. On the first study day, they were randomised to either CPAP or HHFNC each for 2 h, the order being reversed on the second day.
Main Outcome Measures:
The WOB was assessed by measuring the pressure time product of the diaphragm (PTPdi). PTPdi, TAA and SaO2 were assessed during the final 5 min of each 2 h period and the results on the two study days were meaned.
Results:
There were no significant differences in the results on CPAP versus HHFNC: mean PTPdi 226 (range 126-294) versus 224 cm H2O/s/min (95% CI for difference: -27 to 22; p=0.85) (range 170-318) (p=0.82), mean TAA 13.4° (range 4.51°-23.32°) versus 14.01° (range 4.25°-23.86°) (95% CI for difference: -3.9 to 2.8: p=0.73) (p=0.63) and mean SaO2 95% (range 93%-100%) versus 95% (94%-99%), (95% CI for difference -1.8 to 0.5; p=0.25) (p=0.45).
Conclusion:
In infants with evolving or established BPD, CPAP compared with HHFNC offered no significant advantage with regard to the WOB, degree of asynchrony or oxygen saturation.
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