Comparison of the pharyngeal pressure provided by two heated, humidified high‐flow nasal cannulae devices in premature infants

Collins, C; Holberton, James; König, Kai

doi:10.1111/jpc.12277

Cited by 34 publications

(44 citation statements)

References 13 publications

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“…Of note, heated high-flow nasal cannula (HHFNC) systems were not in common use at the time. HHFNC, which is reviewed below, delivers an elevated pharyngeal pressure[34] and thus may cause some infants with severe BPD to be incorrectly categorized as having moderate BPD when the clinical FiO 2 is used to determine BPD severity.…”

Section: Overview Of Lung Developmentmentioning

confidence: 99%

“…HHFNC does not require a tight seal and is thus, unlike nCPAP therapy, not associated with nasal trauma [62]. However, as noted above, these devices have been shown to deliver significant positive pharyngeal pressure [34]. Although HHFNC has clinical benefit, providers ought recognize that HHFNC provides significant respiratory support.…”

Section: Overview Of Lung Developmentmentioning

confidence: 99%

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Disrupted lung development and bronchopulmonary dysplasia

Baker¹,

Alvira

2014

Current Opinion in Pediatrics

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Purpose of review Advances of medical therapy have increased survival of extremely premature infants, and changed the pathology of bronchopulmonary dysplasia (BPD) from one of acute lung injury to a disease of disrupted lung development. With this evolution, new questions emerge regarding: (i) the molecular mechanisms that control postnatal lung development; (ii) the effect of early disruptions of postnatal lung development on long-term lung function; and (iii) the existence of endogenous mechanisms that permit lung regeneration after injury. Recent Findings Recent data demonstrate that a significant component of alveolarization, the final stage of lung development, occurs postnatally. Further, clinical and experimental studies demonstrate that premature birth disrupts alveolarization, decreasing the gas exchange surface area of the lung and causing BPD. BPD is associated with significant short-term morbidity, and new longitudinal, clinical data demonstrate that survivors of BPD have long-standing deficits in lung function, and may be at risk for the development of additional lung disease as adults. Unfortunately, current care is mainly supportive with few effective therapies that prevent or treat established BPD. These studies underscore the need to further elucidate the mechanisms that direct postnatal lung growth, and develop innovative strategies to stimulate lung regeneration. Summary Despite significant improvements in the care and survival of extremely premature infants, BPD remains a major clinical problem. While efforts should remain focused on the prevention of preterm labor and BPD, novel research aimed at promoting postnatal alveolarization offers a unique opportunity to develop effective strategies to treat established BPD.

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Section: Overview Of Lung Developmentmentioning

confidence: 99%

Section: Overview Of Lung Developmentmentioning

confidence: 99%

Disrupted lung development and bronchopulmonary dysplasia

Baker¹,

Alvira

2014

Current Opinion in Pediatrics

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“…Although nHF does generate some distending pressure, this varies with gas flow and leak. Despite initial concerns about excessive pressure generation and risk of pneumothorax, most in vivo studies have shown that pharyngeal pressure generated by nHF is (i) similar to, or below, that generated during CPAP and (ii) increases with increased flow rate . Spence et al .…”

Section: Mechanisms Of Actionmentioning

confidence: 99%

“…For a given flow, the delivered pressure appears to be inversely proportional to an infant's weight, that is, the smallest infants require less flow to generate the same distending pressure as larger infants. One small study compared pressure generated by two nHF devices, Optiflow (Fisher & Paykel, Auckland, New Zealand) and Vapotherm (Vapotherm, Exeter, CA, USA), and showed no pressure differences with flows of 2–6 L/min and slightly higher pharyngeal pressures with Vapotherm at 8 L/min . This may reflect the inclusion of a pressure relief valve in the Optiflow system but not in Vapotherm …”

Section: Mechanisms Of Actionmentioning

confidence: 99%

Nasal high flow therapy for neonates: Current evidence and future directions

Hodgson

Davis

Owen

2019

J Paediatrics Child Health

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Nasal high flow (nHF) therapy is a commonly used method of providing non‐invasive respiratory support for neonates. It has several potential mechanisms of action: continuous distending pressure, nasopharyngeal dead space washout, provision of heated and humidified gases and reduction of work of breathing. nHF is used in a number of clinical scenarios for preterm and term infants, including primary respiratory and post‐extubation support. In recent years, large trials have generated evidence pertinent to these indications. Novel applications for nHF in neonates warrant further research: during endotracheal intubation, for initial delivery room stabilisation of preterm infants and in conjunction with minimally invasive surfactant therapy.

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“…Collins et al. compared pharyngeal pressures using two commonly used HHFNC devices, the Fisher & Paykel Healthcare HHFNC (Auckland, New Zealand) and the Vapotherm 2000 (Vapotherm Inc., Stevensville, MD, USA), in nine infants at flow rates of 2–8 L/min. There was no difference in pharyngeal pressures recorded between devices at flow rates of 2–6 L/min.…”

Section: Delivery Of Distending Pressurementioning

confidence: 99%