Work of breathing indices in infants with respiratory insufficiency receiving high-flow nasal cannula and nasal continuous positive airway pressure

Abstract

OBJECTIVE To compare work of breathing (WOB) indices between two nCPAP settings and two levels of HFNC in a crossover study. STUDY DESIGN Infants with a CGA 28–40 weeks, baseline of HFNC 3–5 lpm or nCPAP 5–6 cmH2O and fraction of inspired oxygen ≤40% were eligible. WOB was analyzed using respiratory inductive plethysmography (RIP) for each of the four modalities: HFNC 3 and 5 lpm, nCPAP 5 and 6 cmH2O. N = 20; Study weight 1516 g (±40 g). RESULT Approximately 12 000 breaths were analyzed indicating a high degree of asynchronous breathing and elevated WOB indices at all four levels of support. Phase angle values (means) (P<0.01): HFNC 3 lpm (114.7°), HFNC 5 lpm (96.7°), nCPAP 5 cmH2O (87.2°), nCPAP 6 cmH2O (80.5°). The mean phase relation of total breath (PhRTB) (means) (P<0.01): HFNC 3 lpm (63.2%), HFNC 5 lpm (55.3%), nCPAP 5 cmH2O (49.3%), nCPAP 6 cmH2O (48.0%). The relative labored breathing index (LBI) (means) (P≤0.001): HFNC 3 lpm (1.39), HFNC 5 lpm (1.31), nCPAP 5 cmH2O (1.29), nCPAP 6 cmH2O (1.26). Eighty-two percent of the study subjects—respiratory mode combinations displayed clustering, in which a proportion of breaths either occurred predominantly out-of-phase (relative asynchrony) or in-phase (relative synchrony). CONCLUSION In this study, WOB indices were statistically different, yet clinically similar in that they were elevated with respect to normal values. These infants with mild-to-moderate respiratory insufficiency demonstrate a meaningful elevation in WOB indices and continue to require non-invasive respiratory support. Patient variability exists with regard to biphasic clustered breathing patterns and the level of supplemental fraction of inspired oxygen ≤40% alone does not provide guidance to the optimal matching of WOB indices and non-invasive respiratory support.

The Objective Use of Pulse Oximetry to Predict Respiratory Support Transition in Preterm Infants: An Observational Pilot Study

“…Although these modes may improve gas exchange by different mechanisms, similar compliance and work of breathing have been noted in prior crossover studies of a range of CPAP/HFNC support. 30,31 In this study, there were no differences in S pO 2 histogram distributions between CPAP and HFNC groups pre-and post-wean. In addition, there was overlap of the highest histogram quintile (Ͼ95%) of the Nellcor oximeter and the target O 2 saturation range for the Ն33 weeks postmenstrual age (90 -97%).…”

pneuRIPTM: A Novel Respiratory Inductance Plethysmography Monitor

“…This off-line analysis is time-consuming, lacks user friendliness, is imprecise, and limits timely clinical evaluation due to late analysis and therefore is ineffective in making treatment decisions. Thus, the RIP, when used with the Respitrace system, is of limited use in the clinic [12][13][14].…”

Effect of nasal noninvasive respiratory support methods on pharyngeal provocation-induced aerodigestive reflexes in infants

“…Due to relatively low expense, ease of administration, and ability to provide developmental support, these noninvasive respiratory support measures are promising and increasingly popular among low-resource nations, where the prevalence of premature birth or volume of high-risk infants is increasing. Comparative clinical trials have been equivocal in their findings with regard to efficacy, effectiveness, or aerodigestive consequences (2,4,31). However, no studies have systematically evaluated the feeding or swallowing reflexes or airway-protective reflexes such as may be activated to protect against airway aspiration in this type of cohort.…”