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Pediatr Pulmonol. 2015 Jul;50(7):713-20. doi: 10.1002/ppul.23060. Epub 2014 May 21.

The effect of high flow nasal cannula therapy on the work of breathing in infants with bronchiolitis.

Author information

1
Paediatric Critical Care Research Group, Mater Research Institute, The University of Queensland, South Brisbane, QLD, 4101, Australia.
2
School of Electrical Engineering and Computer Science, Queensland University of Technology, Brisbane, QLD, 4000, Australia.
3
The School of Nursing and Midwifery, The University of Queensland, Brisbane, QLD, 4006, Australia.

Abstract

The main physiological impact of high flow nasal cannula (HFNC) therapy is presumed to be a decrease in work of breathing (WOB). To assess this, diaphragmatic electrical activity and esophageal pressure changes were measured off then on HFNC delivered at 2 L/kg/min, in 14 infants with bronchiolitis and 14 cardiac infants. Electrical activity of the diaphragm (Edi) was measured using an Edi catheter with calculations of signal peak (EdiMAX ) and amplitude (EdiAMPL ). Pressure-rate and pressure-time products (PRP, PTP) were calculated from analyses of esophageal pressure. Changes in end-expiratory lung volume were measured using respiratory inductance plethysmography (RIPEEL ). The EdiMAX and EdiAMPL were significantly higher in infants with bronchiolitis than in cardiac infants (P < 0.05). Within the bronchiolitis group, both were significantly reduced between HFNC states from 27.9 µV [20.4, 35.4] to 21.0 µV [14.8, 27.2] and from 25.1 µV [18.0, 32.2] to 19.2 µV [13.3, 25.1], respectively (mean, 95% CI, P < 0.05). A less prominent offload of the diaphragm was observed in cardiac infants (P < 0.05). WOB decreased in both groups with a significant reduction of PRP and PTP (P < 0.05). RIPEEL increased significantly in bronchiolitis only (P < 0.05). HFNC offloads the diaphragm and reduces the WOB in bronchiolitis. A similar effect was demonstrated in cardiac infants, a group without signs of airway-obstruction.

KEYWORDS:

breathing pattern; electrical activity of the diaphragm; end expiratory level; esophageal pressure; oxygen therapy; respiratory distress

PMID:
24846750
DOI:
10.1002/ppul.23060
[Indexed for MEDLINE]

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