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Pressure measurements during High Flow Nasal Cannula (HFNC) therapy in infants with a severe airway infection

Hoppenbrouwer, X.L.R. (2016) Pressure measurements during High Flow Nasal Cannula (HFNC) therapy in infants with a severe airway infection.

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Abstract:High-Flow Nasal Cannula (HFNC) therapy is a relative new alternative method for non-invasive respiratory support that is increasingly used in childhood respiratory distress. Using nasal cannula it allows the delivery of heated and humidified oxygen enriched air with a high flow rate. The exact working mechanism of HFNC is largely unraveled and consequently guidelines lack evidence based support. This study aims to explore the possible mechanism of action of HFNC therapy in young children, specifically the clinical effects of HFNC induced airway pressure. Both a clinical pilot study and a laboratory study were performed. During the clinical pilot study, flow and flow-induced pressure inside the HFNC device were recorded simultaneously with relevant physiological variables in infants receiving HFNC therapy to evaluate their relationship. In the laboratory study the difference between the pressure in the HFNC device and at the nasal cannula was measured in order to estimate the generated airway pressure in children included in the clinical pilot study. The pressure and physiological variables data were accurately recorded of 18 patients. A positive linear relationship was found between the applied flow rate and the calculated generated pressure in the nasal cannula, dependent on the type of nasal cannula used. The pressure frequency showed no relationship with the flow rate. In some patients (responders) the heart rate showed a rapid decrease after start of HFNC therapy, while in others this parameter remained constant. In responders the time until the first reduction in flow rate was significantly shorter. In addition the responders showed a larger Q1=kg (ratio baseline flow rate to weight) then the on-responders. This study supports the hypothesis that airway pressure plays a key role in the clinical efficacy of HFNC therapy in infants with respiratory distress. However to further establish the efficiency and the most appropriate settings of HFNC therapy, further research is required.
Item Type:Essay (Master)
Faculty:TNW: Science and Technology
Subject:44 medicine
Programme:Technical Medicine MSc (60033)
Link to this item:http://purl.utwente.nl/essays/70962
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