Abstract
Objective:
To compare work of breathing (WOB) indices between two nCPAP settings and two levels of HFNC in a crossover study.
Study Design:
Infants with a CGA 28–40 weeks, baseline of HFNC 3–5 lpm or nCPAP 5-6 cmH2O and fraction of inspired oxygen ⩽40% were eligible. WOB was analyzed using respiratory inductive plethysmography (RIP) for each of the four modalities: HFNC 3 and 5 lpm, nCPAP 5 and 6 cmH2O. N=20; Study weight 1516 g (±40 g).
Result:
Approximately 12 000 breaths were analyzed indicating a high degree of asynchronous breathing and elevated WOB indices at all four levels of support. Phase angle values (means) (P<0.01): HFNC 3 lpm (114.7°), HFNC 5 lpm (96.7°), nCPAP 5 cmH2O (87.2°), nCPAP 6 cmH2O (80.5°). The mean phase relation of total breath (PhRTB) (means) (P<0.01): HFNC 3 lpm (63.2%), HFNC 5 lpm (55.3%), nCPAP 5 cmH2O (49.3%), nCPAP 6 cmH2O (48.0%). The relative labored breathing index (LBI) (means) (P⩽0.001): HFNC 3 lpm (1.39), HFNC 5 lpm (1.31), nCPAP 5 cmH2O (1.29), nCPAP 6 cmH2O (1.26). Eighty-two percent of the study subjects—respiratory mode combinations displayed clustering, in which a proportion of breaths either occurred predominantly out-of-phase (relative asynchrony) or in-phase (relative synchrony).
Conclusion:
In this study, WOB indices were statistically different, yet clinically similar in that they were elevated with respect to normal values. These infants with mild-to-moderate respiratory insufficiency demonstrate a meaningful elevation in WOB indices and continue to require non-invasive respiratory support. Patient variability exists with regard to biphasic clustered breathing patterns and the level of supplemental fraction of inspired oxygen ⩽40% alone does not provide guidance to the optimal matching of WOB indices and non-invasive respiratory support.
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Acknowledgements
We would like to thank the parents and families in the Neonatal Intensive Care Unit. This study was supported by Nemours Biomedical Research (THS), NIH COBRE P20 GM 103464-8 (THS), Christiana Neonatal Research (RL, BDJ) and NIGMS T32-GM08562 (ER) pediatric clinical pharmacology fellow funded by NICHD.
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de Jongh, B., Locke, R., Mackley, A. et al. Work of breathing indices in infants with respiratory insufficiency receiving high-flow nasal cannula and nasal continuous positive airway pressure. J Perinatol 34, 27–32 (2014). https://doi.org/10.1038/jp.2013.120
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DOI: https://doi.org/10.1038/jp.2013.120
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