Comparison of Effort of Breathing for Infants on Nasal Modes of Respiratory Support.
J Pediatr
; 185: 26-32.e3, 2017 06.
Article
em En
| MEDLINE
| ID: mdl-28366356
ABSTRACT
OBJECTIVE:
To directly compare effort of breathing between high flow nasal cannula (HFNC), nasal intermittent mechanical ventilation (NIMV), and nasal continuous positive airway pressure (NCPAP). STUDYDESIGN:
This was a single center prospective cross-over study for patients <6 months in the cardiothoracic or pediatric intensive care unit receiving nasal noninvasive respiratory support after extubation. We measured effort of breathing using esophageal manometry with pressure-rate product (PRP) on all 3 modes. NIMV synchrony was determined by comparing patient efforts (esophageal manometry) with mechanically delivered breaths (spirometry in ventilator circuit). On NIMV, PRP and synchrony was also measured after adding a nasal clip on 26 patients.RESULTS:
Forty-two children were included. Median (IQR) age was 2 (0.5, 4) months. There was no difference in median PRP between HFNC 6 liters per minute, 355 (270,550), NIMV 12/5 cm H2O, 341 (235, 472), and NCPAP 5 cm H2O, 340 (245,506) (P?=?.33). Results were similar regardless of HFNC flow rate or NIMV inspiratory pressure. Median PRP on CPAP of 5 cm H2O prior to extubation 255 (176, 375) was significantly lower than all postextubation values (P?.002). On NIMV, less than 50% of patient efforts resulted in a ventilator breath, which was not improved with a nasal clip (P?>?.07)). However, as NIMV synchrony improved (>60%), PRP on NIMV was lower than on HFNC.CONCLUSIONS:
For infants, effort of breathing is similar on HFNC, NIMV, and NCPAP after extubation, regardless of flow rate or inspiratory pressure. We speculate that bi-level NIMV may be superior if high levels of synchrony can be achieved.Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Oxigenoterapia
/
Trabalho Respiratório
/
Ventilação com Pressão Positiva Intermitente
/
Pressão Positiva Contínua nas Vias Aéreas
/
Extubação
Tipo de estudo:
Clinical_trials
/
Observational_studies
Limite:
Female
/
Humans
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Infant
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Male
/
Newborn
Idioma:
En
Ano de publicação:
2017
Tipo de documento:
Article