A59-17 Comparison of Nasopharyngeal Airway Pressure Delivery via Non-Invasive Respiratory Support in Infants

Background

There are several nasal interface devices, such as the FlexiTrunk (Fisher & Paykel, Costa Mesa, CA) interface, the Optiflow Junior high flow cannula (Fisher & Paykel), and the RAM cannula (CA), used in neonates to provide non-invasive ventilation. It is important to provide consistent positive airway pressure during non-invasive ventilation to maintain functional residual capacity (FRC) of the lungs and prevent alveolar collapse (atelectasis). An in vivo study has not been done to determine the nasopharyngeal pressure (a surrogate for airway pressure) delivered by various nasal interfaces in infants.

Objective

To measure the nasopharyngeal airway pressure delivered by three nasal interfaces, the Flexi trunk interface (Group 1), the Optiflow Junior cannula (group 2), and the RAM cannula (Group 3) in infants.

Design/Methods

In this single-center prospective cohort pilot study, infants of 23-44 weeks postmenstrual age admitted to the NICU with noninvasive ventilation were included. Infants with mid-facial anomalies, hypoplasia, and known chromosomal anomalies were excluded. Following consent, a nasopharyngeal catheter connected to a NAPA measuring device was kept in place for 4 hours to obtain pressure readings, which were recorded hourly. The mean pressure readings were compared among the three groups using repeated ANOVA (SAS software).

Results

22 patients were included in this study. Each patient had about 5 data points in 4 hours of measurement. Thus, Group 1 had 11 patients with 53 (2 missing) data points, Group 2 had 9 patients with 45 data points and Group 3 had 2 patients with 10 data points for comparison. The mean pressure difference trend among the three groups are shown in Figure A, B and C. The NP pressure difference between set pressure/flow rate and measured pressure compared among Group 1, Group 2 and Group 3 as 1.07 cmH2O, 1.8 cmH2O and 6.49 cmH2O respectively. The mean pressure difference was significant between RAM cannula and Optijunior (p = 0.0029) as well as Flexitrunk (p = 0.0014) (Figure D).

Conclusion

Our findings demonstrate that NIV interface - RAM cannula had the highest mean pressure difference between the set pressure and measured pressure. Nasopharyngeal pressure monitoring device may be useful to determine the actual pressure being delivered by the NIV interface.

This abstract is funded by: None