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Pharyngeal pressure with high-flow nasal cannulae in premature infants

Journal of Perinatology volume 28, pages 42–47 (2008)Cite this article

Abstract

Objective:

The aim of this study was to measure pharyngeal pressures in preterm infants receiving high-flow nasal cannulae.

Study Design:

A total of 18 infants were studied (median gestational age 34 weeks, weight 1.619 kg). A catheter-tip pressure transducer was introduced into the nasopharynx. Flow was sequentially increased to a maximum of 8 l min−1 and decreased to a minimum of 2 l min−1.

Result:

There was a strong association between pharyngeal pressure and both flow rate and infant weight (P<0.001, r2=0.61), but not mouth closure. This relationship could be expressed as pharyngeal pressure (cm H2O)=0.7+1.1 F (F=flow per kg in l min−1 kg−1).

Conclusion:

High-flow nasal cannulae at flow rates of 2 to 8 l min−1 can lead to clinically significant elevations in pharyngeal pressure in preterm infants. Flow rate and weight but not mouth closure are important determinants of the pressure transmitted.

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Acknowledgements

We thank Peter Dwyer at the Mercy Hospital for Women for the loan of catheter-tip pressure transducers and associated equipment. Susan Donath and John Carlin at the Clinical Epidemiology and Biostatistics Unit, University of Melbourne provided expert statistical advice. Chris Wittwer and the other diligent staff at CSSD kindly helped with sterilization of catheters.

Financial Support: No extramural financial support was used for this study. The Medical Research Foundation for Women and Babies provided funding for the purchase of pressure transducers.

Author information

Authors and Affiliations

  1. Department of Paediatrics, Mercy Hospital for Women, Melbourne, VIC., Australia

    D J Wilkinson, C C Andersen & J Holberton

  2. Neonatal Unit, Royal Children's Hospital, Parkville, VIC., Australia

    D J Wilkinson

  3. Neonatal Unit, Women's and Children's Hospital, Adelaide, SA, Australia

    C C Andersen

  4. Clinical Epidemiology and Biostatistics Unit, Murdoch Children's Research Institute, Melbourne, VIC., Australia

    K Smith

Authors
  1. D J Wilkinson
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  2. C C Andersen
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  3. K Smith
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  4. J Holberton
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Corresponding author

Correspondence to D J Wilkinson.

Additional information

This study was undertaken in the neonatal unit, Mercy Hospital for Women.

Disclosure/Conflict of Interest

The authors do not have any duality of interests.

Appendix

Appendix

Alternative prediction model

Since regression residuals were found to increase with flow rate, a zero-skewness logarithmic transformation was applied to the outcome to provide an alternative prediction model with constant variance (Figure 4).

Figure 4
figure 4

Pharyngeal pressure vs flow per kg. Log-transformed linear regression with 95% confidence interval.

Full size image

Predicted pharyngeal pressure (cm water)=e(2.1947+0.075303F−0.14711 wt)−6.2436.

Results using this model were similar to those obtained using the untransformed regression equation.

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Wilkinson, D., Andersen, C., Smith, K. et al. Pharyngeal pressure with high-flow nasal cannulae in premature infants. J Perinatol 28, 42–47 (2008). https://doi.org/10.1038/sj.jp.7211879

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