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Nasal high flow in preterm infants: A dose-finding study

Judith L Hough1,2,3, Andrew D Shearman1, Luke Jardine1

  • 1Program for Optimising Outcomes for Mothers and Babies At-Risk, Mater Research Institute, The University of Queensland, South Brisbane, Queensland, Australia.

Pediatric Pulmonology
|December 24, 2019
PubMed

Insights

Nasal high flow (NHF) at 4, 6, and 8 L/min may equally reduce work of breathing (WOB) in preterm infants. This study measured diaphragm and intercostal muscle activity to assess WOB changes with varying NHF.

Area of Science:

  • Neonatal respiratory support
  • Pediatric critical care
  • Respiratory physiology

Background:

  • Preterm infants often require respiratory support.
  • Nasal high flow (NHF) is a common method, but optimal flow rates for reducing work of breathing (WOB) are debated.
  • Understanding the relationship between NHF and WOB is crucial for improving infant outcomes.

Purpose of the Study:

  • To investigate the impact of different NHF rates on physiological outcomes and WOB in preterm infants.
  • To identify an optimal NHF delivery flow that minimizes WOB.
  • To correlate NHF levels with specific physiological parameters.

Main Methods:

  • A prospective observational study was conducted on preterm infants receiving NHF.
  • Randomized NHF rates (2, 4, 6, and 8 L/min) were applied, with WOB measured via transcutaneous electromyography and respiratory inductance plethysmography.
  • Physiological variables and muscle electrical activity were recorded and compared across different flow rates.

Main Results:

  • Changes in NHF flow rates significantly altered diaphragm and intercostal muscle activity.
  • Diaphragmatic electrical activity was lowest at 8 L/min compared to 2 L/min.
  • Respiratory rate was lowest at 6 L/min, and SpO2/FiO2 was highest at 8 L/min.

Conclusions:

  • Transcutaneous electromyography effectively demonstrates NHF-induced WOB changes in preterm infants.
  • NHF flows of 4, 6, and 8 L/min appear equally effective in reducing WOB.
  • Further research may refine optimal NHF settings for preterm neonates.
Abstract

Keywords:
diaphragmelectromyographyhigh-flow nasal cannulaoxygen delivery

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