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Research ArticleOriginal Research

Positive End-Expiratory Pressure Effect of 3 High-Flow Nasal Cannula Devices

Jing-chao Luo, Mei-shan Lu, Zhi-hong Zhao, Wei Jiang, Biao Xu, Li Weng, Tong Li and Bin Du
Respiratory Care July 2017, 62 (7) 888-895; DOI: https://doi.org/10.4187/respcare.05337
Jing-chao Luo
Medical Intensive Care Unit, Peking Union Medical College Hospital, Beijing, China.
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Mei-shan Lu
Medical Intensive Care Unit, Peking Union Medical College Hospital, Beijing, China.
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Zhi-hong Zhao
Department of Clinical Medicine, Peking Union Medical College, Beijing, China.
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Wei Jiang
Medical Intensive Care Unit, Peking Union Medical College Hospital, Beijing, China.
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Biao Xu
Medical Intensive Care Unit, Peking Union Medical College Hospital, Beijing, China.
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Li Weng
Medical Intensive Care Unit, Peking Union Medical College Hospital, Beijing, China.
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Tong Li
Department of Critical Care Medicine, Beijing Tongren Hospital, Capital Medical University, Beijing, China.
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Bin Du
Medical Intensive Care Unit, Peking Union Medical College Hospital, Beijing, China.
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  • For correspondence: [email protected]
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Abstract

BACKGROUND: High-flow nasal cannula (HFNC) is supposed to provide additional PEEP compared with conventional oxygen therapy. However, the exact determinants of this PEEP effect are unclear. We investigated the factors that might affect the PEEP and compared PEEP performance among 3 HFNC devices.

METHODS: Three available HFNC devices were evaluated: the AIRVO 2 device and 2 mechanical ventilators (SV300 and Monnal T75). A device consisting of a test lung (5600i) and an airway model (AMT(IE)) was used to simulate spontaneous breathing. The flows ranged from 0 to their maximum flow with an interval of 10 L/min. The pressures were measured at 4 sites (nasopharynx, supraglottis, carina, and lung) under compliances of 50 and 100 mL/cm H2O and tidal volume of 300, 500, and 700 mL with the mouth closed or open. The influencing factors were determined by multiple linear regression. The sum of squares reduction test was used to compare working curves of PEEP effect among 3 devices. Pairwise comparisons were conducted by using Tukey's multiple comparisons test within an overlap of flow from 0 to 50 L/min.

RESULTS: A quadratic curved relationship between PEEP and flow was observed (coefficients were 8.97 × 10−3 for flow and 4.79 × 10−4 for a quadratic element of flow, respectively) but evanished when the mouth was open. The PEEP increased along with lung compliance (coefficient was 2.58 × 10−3). Despite the difference in working curves, both the mechanical ventilators performed slightly better than the AIRVO 2 device at higher flows (40 and 50 L/min).

CONCLUSIONS: The mouth status, flow, and compliance were the 3 major influencing factors of PEEP effect, whereas performance of the 2 mechanical ventilators was slightly superior to that of the AIRVO 2 device at higher flows.

  • PEEP effect
  • HFNC device
  • AIRVO 2 system
  • ventilator

Footnotes

  • Correspondence: Bin Du MD, Medical Intensive Care Unit, Peking Union Medical College Hospital, 1 Shuai Fu Yuan, Beijing 100730, China. E-mail: dubin98{at}gmail.com.
  • The authors have disclosed no conflicts of interest.

  • Copyright © 2017 by Daedalus Enterprises
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Respiratory Care: 62 (7)
Respiratory Care
Vol. 62, Issue 7
1 Jul 2017
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Positive End-Expiratory Pressure Effect of 3 High-Flow Nasal Cannula Devices
Jing-chao Luo, Mei-shan Lu, Zhi-hong Zhao, Wei Jiang, Biao Xu, Li Weng, Tong Li, Bin Du
Respiratory Care Jul 2017, 62 (7) 888-895; DOI: 10.4187/respcare.05337

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Positive End-Expiratory Pressure Effect of 3 High-Flow Nasal Cannula Devices
Jing-chao Luo, Mei-shan Lu, Zhi-hong Zhao, Wei Jiang, Biao Xu, Li Weng, Tong Li, Bin Du
Respiratory Care Jul 2017, 62 (7) 888-895; DOI: 10.4187/respcare.05337
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Keywords

  • PEEP effect
  • HFNC device
  • AIRVO 2 system
  • ventilator

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