HIGH FLOW NASAL CANNULA AIRWAY PRESSURE INTERROGATION
CCCF ePoster library. Giraldo Salazar J. Oct 31, 2016; 150890; 18 Disclosure(s): Grant: McMaster Resident Research Award
Juliana Giraldo Salazar
Juliana Giraldo Salazar
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Topic: Retrospective or Prospective Cohort Study

HIGH FLOW NASAL CANNULA AIRWAY PRESSURE INTERROGATION


Giraldo, Juliana1; Alshueili,Hamood1; Cheng,Ji2; Thabane, Lehana2; Monkman, Shelley3; Nykolaychuk, Allison1; Choong, Karen1
1
Deparment of Pediatrics, McMaster University, Hamilton, Canada; 2Department of Clinical epidemiology and Biostatistics, McMaster University, Hamilton, Canada; 3Department of Neonatology, McMaster University, Hamilton, Canada


Grant acknowledgements:
This study was funded by the Department of Paediatrics at McMaster University

Abstract:

Introduction: Humidified High Flow Nasal cannula therapy (HHFNC) is an increasingly common mode of respiratory support in pediatrics. While proposed to generate positive airway pressure, the amount of airway pressure delivered by newer HHFNC devices has not been adequately evaluated. The objectives of this study were to 1) measure the airway pressure delivered, and 2) evaluate the variables that may influence the delivery of positive airway pressure, during HHFNC.

Methods: Prospective observational cohort study at McMaster Children`s Hospital, Pediatric Critical Care Unit (PCCU), Canada. Children under 18 years on HHFNC support (Optiflow JrTM) were eligible. Esophageal pressure (Pes) was measured as a surrogate for airway pressure, using a previously validated method. The primary outcome was the relationship between delivered flow rates on HHFNC, and Pes (analysed using analysis of variance). Secondary endpoints included predictors of Pes during HHFNC. We hypothesized that patient size, disease severity and work of breathing may influence Pes, and planned to  analyze these potential predictors using regression methods.

Preliminary Results: Thirty-four Pes measurements have been conducted in a total of 12 patients to date. Patients ranged from 12 days of age to 13 years, the median weight was 5.88 kg (3.2 - 89 Kg), and 9 (75%) were males. The commonest diagnoses necessitating HHFNC in these patients were pneumonia and bronchiolitis. HHFNC flow rates ranged from minimum of 5 to maximum of 25L/min. HHFNC generated median Pes of 5.5 (range 2 – 11.5) in infants, and 8 (5-11) cm H2O in children. While there was a moderate positive linear correlation between HHFNC flow rate and Pes (Pearson correlation coefficient of 0.486), we observed a ceiling effect with HHFNC. Regression analyses are underway to evaluate predictors that may affect Pes generated by HHFNC in this population.

Conclusion: HHFNC generates measurable airway end-distending pressure, which correlates moderately with delivered flow rates, but only to a maximum of 11.5 cm H2O. Different patient characteristics may play a role in the amount of airway pressure generated.

Key words: HHFNC, high flow, airway pressure, esophageal pressure, children.
 


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