Sivieri Emidio M, Foglia Elizabeth E, Abbasi Soraya
Section on Newborn Pediatrics, Pennsylvania Hospital, Philadelphia, Pennsylvania.
Division of Neonatology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
Pediatr Pulmonol. 2017 Jun;52(6):792-798. doi: 10.1002/ppul.23664. Epub 2017 Feb 6.
To compare CO washout time at different levels of HFNC versus NCPAP in a premature infant lung model with simulated mouth-closed and mouth-open conditions using two sizes of nasal cannula and full- and half-prong HFNC insertion depths.
DESIGN/METHODS: A piston-cylinder lung simulator, having a fixed volume of 30 ml and a 4.8 ml dead space, simulated spontaneous breathing (6.5 ml tidal volume, 50 br/min, Ti = 0.5 sec). Two Fisher & Paykel™ cannulas (Fisher & Paykel Healthcare Ltd., Auckland, New Zealand) (2.8 and 3.2 mm O.D.) and two Infant-Flow™ (CareFusion, Yorba Linda, CA) NCPAP cannulas (3.4 and 4.1 mm O.D.) were applied to simulated airways having either 3.5 or 4.5 mm I.D. nares. Simulated mouth opening was a 5 mm I.D. side tap below the nasal interface. The lung was primed with 5% CO . Washout times were determined at HFNC settings of 3, 4, 5, 6, and 8 L/min and NCPAP at 3, 4, 5, 6, and 8 cm H O with simulated open and closed-mouth conditions and full- and half-inserted HFNC prongs.
Overall combined mean washout times for NCPAP with mouth-closed were significantly longer than HFNC over all five pressure and flow device settings by 16.2% (P < 0.001). CO washout times decreased as flow or pressure device settings were increased. There were negligible differences in washout times between NCPAP and HFNC with mouth-open. Mouth-open washout times were significantly less than mouth-closed for all conditions. Overall closed-mouth washout times for HFNC half-prong insertion were longer than for full-prong insertion by 5.3% (P < 0.022).
Significantly improved CO elimination using HFNC versus NCPAP should be a particularly important consideration in premature infants having very high dead space-to-tidal volume ratio compared to larger infants. Pediatr Pulmonol. 2017;52:792-798. © 2017 Wiley Periodicals, Inc.
在模拟口闭和口开条件下的早产婴儿肺模型中，使用两种尺寸的鼻导管以及全插入和半插入深度的高流量鼻导管（HFNC），比较不同水平的HFNC与鼻塞持续气道正压通气（NCPAP）时的一氧化碳清除时间。
设计/方法：一个活塞 - 气缸肺模拟器，固定容积为30毫升，死腔为4.8毫升，模拟自主呼吸（潮气量6.5毫升，每分钟50次呼吸，吸气时间0.5秒）。将两个费雪派克™鼻导管（费雪派克医疗保健有限公司，新西兰奥克兰）（外径2.8和3.2毫米）和两个婴儿流量™（CareFusion，加利福尼亚州约巴林达）NCPAP鼻导管（外径3.4和4.1毫米）应用于内径为3.5或4.5毫米的模拟气道。模拟口开是在鼻接口下方一个内径5毫米的侧孔。肺用5%的一氧化碳进行预充。在HFNC设置为3、4、5、6和8升/分钟以及NCPAP设置为3、4、5、6和8厘米水柱的情况下，在模拟的口开和口闭条件以及HFNC全插入和半插入的情况下测定清除时间。
在所有五个压力和流量设备设置下，口闭时NCPAP的总体综合平均清除时间比HFNC长16.2%（P < 0.001）。一氧化碳清除时间随着流量或压力设备设置的增加而减少。口开时NCPAP和HFNC之间的清除时间差异可忽略不计。在所有情况下，口开时的清除时间明显少于口闭时。HFNC半插入时的总体口闭清除时间比全插入时长5.3%（P < 0.022）。
与较大婴儿相比，对于死腔与潮气量比值非常高的早产儿，使用HFNC与NCPAP相比能显著改善一氧化碳清除，这应是一个特别重要的考虑因素。《儿科肺脏病学》。2017年；第５２卷：７９２ - ７９８页。© 2017威利期刊公司
