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

Pham, Trang M. T., O'Malley, Lee, Mayfield, Sara, Martin, Simon and Schibler, Andreas (2015) The effect of high flow nasal cannula therapy on the work of breathing in infants with bronchiolitis. Pediatric Pulmonology, 50 7: 713-720. doi:10.1002/ppul.23060


Author Pham, Trang M. T.
O'Malley, Lee
Mayfield, Sara
Martin, Simon
Schibler, Andreas
Title The effect of high flow nasal cannula therapy on the work of breathing in infants with bronchiolitis
Journal name Pediatric Pulmonology   Check publisher's open access policy
ISSN 8755-6863
1099-0496
Publication date 2015-07-01
Sub-type Article (original research)
DOI 10.1002/ppul.23060
Open Access Status Not Open Access
Volume 50
Issue 7
Start page 713
End page 720
Total pages 8
Place of publication Hoboken, NJ, United States
Publisher John Wiley & Sons
Language eng
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.
Keyword Oxygen therapy
Breathing pattern
Respiratory distress
Electrical activity of the diaphragm
Esophageal pressure
End expiratory level
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

 
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