ORIGINAL ARTICLE

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

Corresponding Author

Judith L. Hough PhD

[email protected]

orcid.org/0000-0002-4264-9823

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

School of Allied Health, Australian Catholic University, Banyo, Queensland, Australia

Pediatric Critical Care Research Group, Child Health Research Centre, The University of Queensland, South Brisbane, Queensland, Australia

Correspondence Judith L. Hough, School of Allied Health, Australian Catholic University, Banyo, QLD 4014, Australia.

Email: [email protected]

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Andrew D. Shearman MClinSc,

Andrew D. Shearman MClinSc

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

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Luke Jardine FRACP,

Luke Jardine FRACP

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

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Andreas Schibler FCICM,

Andreas Schibler FCICM

Pediatric Critical Care Research Group, Child Health Research Centre, The University of Queensland, South Brisbane, Queensland, Australia

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Judith L. Hough PhD,

Corresponding Author

Judith L. Hough PhD

[email protected]

orcid.org/0000-0002-4264-9823

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

School of Allied Health, Australian Catholic University, Banyo, Queensland, Australia

Pediatric Critical Care Research Group, Child Health Research Centre, The University of Queensland, South Brisbane, Queensland, Australia

Correspondence Judith L. Hough, School of Allied Health, Australian Catholic University, Banyo, QLD 4014, Australia.

Email: [email protected]

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Andrew D. Shearman MClinSc,

Andrew D. Shearman MClinSc

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

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Luke Jardine FRACP,

Luke Jardine FRACP

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

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Andreas Schibler FCICM,

Andreas Schibler FCICM

Pediatric Critical Care Research Group, Child Health Research Centre, The University of Queensland, South Brisbane, Queensland, Australia

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First published: 23 December 2019

https://doi.org/10.1002/ppul.24617

Citations: 8

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Abstract

Objective

To investigate the relationship between applied flows of nasal high flow (NHF) and physiological outcomes and work of breathing (WOB), to identify an optimal delivery flow which results in reduced WOB in preterm infants.

Design

A prospective observational clinical study with randomly applied NHF rates.

Patients and Setting

Preterm infants within 72 hours of commencement of NHF respiratory support.

Interventions

Infants were initially placed on 8 L/min of NHF and flows of 2, 4, and 6 L/min were then applied in random order.

Measurements and Results

WOB was measured using transcutaneous electromyography and respiratory inductance plethysmography. Physiological variables were also recorded. Measurements taken 10 minutes after each flow change were compared with 8 L/min. Sixteen infants with a median gestational age of 28 (range 24-31) weeks and postnatal age of 14 (2-55) days were included in the study. The median flow rate before the study was 6 (4-8) L/min and a fraction of inspired oxygen (FiO₂) was 0.21 (0.21-0.26). Changes in flow resulted in changes in activity in the front diaphragm (P = .027) and intercostals (P = .034). The electrical activity of the front diaphragm at 8 L/min was significantly lower than that at 2 L/min (P = .016). Respiratory rate was lowest at 6 L/min (P = .002) and SpO₂/FiO₂ was highest at 8 L/min (P < .04).

Conclusion

In preterm infants, changes in WOB resulting from randomly applied levels of NHF can be demonstrated by measuring the electrical activity of the diaphragm and intercostal muscles with transcutaneous electromyography. In combination with physiological measurements, the similarities in electrical activity between 4, 6, and 8 L/min suggest that these three flows may be equally as effective.

CONFLICT OF INTERESTS

AS and JLH have received support for travel and accommodation from Fisher & Paykel to attend conference presentations. Remaining authors declare that there are no conflict of interests.

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Volume55, Issue3

March 2020

Pages 616-623

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

Abstract

Objective

Design

Patients and Setting

Interventions

Measurements and Results

Conclusion

CONFLICT OF INTERESTS

REFERENCES

Citing Literature

References

Information

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

Abstract

Objective

Design

Patients and Setting

Interventions

Measurements and Results

Conclusion

CONFLICT OF INTERESTS

REFERENCES

Citing Literature

References

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