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European Journal of Pediatrics

, Volume 178, Issue 1, pp 105–110 | Cite as

Work of breathing during HHHFNC and synchronised NIPPV following extubation

  • Elinor CharlesEmail author
  • Katie A. HuntEmail author
  • Gerrard F. Rafferty
  • Janet L. Peacock
  • Anne GreenoughEmail author
Original Article

Abstract

Our aim was to compare the work of breathing (WOB) during synchronised nasal intermittent positive pressure ventilation (SNIPPV) and heated humidified high flow nasal cannula (HHHFNC) when used as post-extubation support in preterm infants. A randomised crossover study was undertaken of nine infants with a median gestational age of 27 (range 24–31) weeks and post-natal age of 7 (range 2–50) days. Infants were randomised to either SNIPPV or HHHFNC immediately following extubation. They were studied for 2 h on one mode and then switched to the other modality and studied for a further 2-h period. The work of breathing, assessed by measuring the pressure time product of the diaphragm (PTPdi), and thoracoabdominal asynchrony (TAA) were determined at the end of each 2-h period. The infants’ inspired oxygen requirement, oxygen saturation, heart rate and respiratory rate were also recorded. The median PTPdi was lower on SNIPPV than on HHHFNC (232 (range 130–352) versus 365 (range 136–449) cmH2O s/min, p = 0.0077), and there was less thoracoabdominal asynchrony (13.4 (range 8.5–41.6) versus 36.1 (range 4.3–50.4) degrees, p = 0.038).

Conclusion: In prematurely born infants, SNIPPV compared to HHHFNC post-extubation reduced the work of breathing and thoracoabdominal asynchrony.

What is Known:

• The work of breathing and extubation failure are not significantly different in prematurely-born infants supported by HHHFNC or nCPAP.

• SNIPPV reduces inspiratory effort and increases tidal volume and carbon dioxide exchange compared to nCPAP in prematurely born infants.

What is New:

• SNIPPV, as compared to HHHFNC, reduced the work of breathing in prematurely-born infants studied post-extubation.

• SNIPPV, as compared to HHHFNC, reduced thoracoabdominal asynchrony in prematurely born infants studied post-extubation.

Keywords

Non-invasive ventilation Prematurity Post-extubation support 

Abbreviations

AB

Abdominal movement

ABdiff

Difference between inspiratory and expiratory abdominal positions at mid-RC excursion

ABmax

Maximum abdominal excursion

BPD

Bronchopulmonary dysplasia

CPAP

Continuous positive airway pressure

FiO2

Inspired oxygen fraction

HHHFNC

Heated humidified high flow nasal cannula

PdI

Transdiaphragmatic pressure

PEEP

Positive end expiratory pressure

Pgas

Gastric pressures

PIP

Peak inspiratory pressures

Poes

Oesophageal pressure

PTPdi

Pressure time product of the diaphragm

RC

Rib cage movement

RIP

Respiratory inductance plethysmography

SNIPPV

Synchronised nasal intermittent positive pressure ventilation

TAA

Thoracoabdominal asynchrony

WOB

Work of breathing

Notes

Authors’ Contributions

AG, KAH and GFR designed the study. EC and KAH collected the data. JFP, EC, KAH and AG analysed the data. All authors were involved in the production of the manuscript and approved the final version.

Funding

Dr. Hunt was supported by the Charles Wolfson Charitable Trust and additionally by SLE. Dr. Elinor Charles was supported by the Isaac Shapera Fund. The research was supported by the National Institute for Health Research (NIHR) Biomedical Research Centre based at Guy’s and St Thomas’ NHS Foundation Trust and King’s College London. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health. Professor Janet Peacock is an NIHR Senior Investigator. The Guilia ventilated was loaned to us by Gineviri Medical Technologies (see comments re competing interests).

Compliance with ethical standards

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Conflict of interest

Professor Greenough has held grants from various manufacturers (Abbot Laboratories, MedImmune) and ventilator manufacturers (SLE). Professor Greenough has received honoraria for giving lectures and advising various manufacturers (Abbot Laboratories, MedImmune) and ventilator manufacturers (SLE). Professor Greenough is currently receiving a non-conditional educational grant from SLE. The Guilia ventilator was loaded to us by Ginevri Medical Technologies; they have not been involved in the data collection analysis or production of the manuscript.

Informed consent

Infants whose parents gave informed written consent were enrolled into the study.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.MRC & Asthma UK Centre for Allergic Mechanisms in AsthmaKing’s College LondonLondonUK
  2. 2.Department of Women and Children’s Health, School of Life Course Sciences, Faculty of Life Sciences and MedicineKing’s College LondonLondonUK
  3. 3.Centre for Human and Aerospace Physiological Sciences, Faculty of Life Sciences and MedicineKing’s College LondonLondonUK
  4. 4.School of Population Health and Environmental SciencesKing’s College LondonLondonUK
  5. 5.National Institute for Health Research (NIHR) Biomedical Research Centre based at Guy’s and St Thomas’ NHS Foundation Trust and King’s College LondonLondonUK

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