Year-end Sale % OFF 
Abstract
BackgroundFor children and adults, the standard treatment for obstructive sleep apnea is the delivery of continuous positive airway pressure (CPAP). Though effective, CPAP masks can be uncomfortable to patients, contributing to adherence concerns. Recently, nasal high flow (NHF) therapy has been investigated as an alternative, especially in CPAP-intolerant children. The present study aimed to compare and contrast the positive airway pressures and expired gas washout generated by NHF versus CPAP in child nasal airway replicas.MethodsNHF therapy was investigated at a flow rate of 20 L/min and compared to CPAP at 5 cmH2O and 10 cmH2O for 10 nasal airway replicas, built from computed tomography scans of children aged 4–8 years. NHF was delivered with three different high flow nasal cannula models provided by the same manufacturer, and CPAP was delivered with a sealed nasal mask. Tidal breathing through each replica was imposed using a lung simulator, and airway pressure at the trachea was recorded over time. For expired gas washout measurements, carbon dioxide was injected at the lung simulator, and end-tidal carbon dioxide (EtCO2) was measured at the trachea. Changes in EtCO2 compared to baseline values (no intervention) were assessed.ResultsNHF therapy generated an average positive end-expiratory pressure (PEEP) of 5.17 ± 2.09 cmH2O (mean ± SD, n = 10), similar to PEEP of 4.95 ± 0.03 cmH2O generated by nominally 5 cmH2O CPAP. Variation in tracheal pressure was higher between airway replicas for NHF compared to CPAP. EtCO2 decreased from baseline during administration of NHF, whereas it increased during CPAP. No statistical difference in tracheal pressure nor EtCO2 was found between the three high flow nasal cannulas.ConclusionIn child airway replicas, NHF at 20 L/min generated average PEEP similar to CPAP at 5 cm H2O. Variation in tracheal pressure was higher between airway replicas for NHF than for CPAP. The delivery of NHF yielded expired gas washout, whereas CPAP impeded expired gas washout due to the increased dead space of the sealed mask.
Highlights
For children and adults, the standard treatment for obstructive sleep apnea is the delivery of continuous positive airway pressure (CPAP)
From Analysis of Variance (ANOVA), the selection between CPAP and nasal high flow (NHF) was observed to have a significant influence on tracheal pressures
5 cmH2O CPAP was different from 10 c mH2O CPAP for all four pressure parameters, but different from NHF only in terms of peak expiratory pressure (PEP) and minimum inspiratory pressure (MIP). 10 cmH2O CPAP was different from NHF in terms of positive end-expiratory pressure (PEEP), MIP, and average inspiratory pressure (AIP)
Summary
The standard treatment for obstructive sleep apnea is the delivery of continuous positive airway pressure (CPAP). Nasal high flow (NHF) therapy has been investigated as an alternative, especially in CPAP-intolerant children. OSA affects both adults and children, but the consequences of the disorder may differ between the two groups. The delivery of continuous positive airway pressure (CPAP) is an effective treatment for OSA in children [9, 10]. With the goal of improving adherence to CPAP therapy, several groups have investigated improvements to the comfort of the mask interface [16,17,18,19]. Other groups have explored alternative forms of noninvasive respiratory support, including administration of nasal high flow (NHF) therapy [20, 21]
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
