The Science Journal of the American Association for Respiratory Care

2005 OPEN FORUM Abstracts

High Flow Nasal Cannula Vs NCPAP in Premature Infants

Shellie O'Day, MS, CRT. Alisa Pap, BS, RRT. Phyllis Jenkins, RRT. Marjorie Beasley, RRT, BSRT. Jean Wright, MD, MBA. Memorial Health University Medical Center, Savannah, GA.

Introduction: Traditionally, nCPAP has been the method to deliver non-invasive PEEP blended oxygen to premature infants. However, common problems occur with the sizing the prongs, comfort to the patient, and skin breakdown. Formerly, our extubation were followed by administration of nCPAP or low flow nasal cannula. For the preceding year, our NICU has been using the Vapotherm TM 2000i to deliver respiratory assistance without the complication of nCPAP. We compared extubation outcomes with nCPAP / Vapotherm verses vapotherm alone.

Methods: following mechanical ventilation eleven patients were entered into two groups. Group 1 was extubated, placed in nCPAP at 5-6 cm H2O and progressed to Vapotherm at 3-6 L/min. Group 2 was extubated directly to Vapotherm at 3-6 L/min. Arterial blood gases was collected for patients.

Results:
In both groups ABG and CXR remain closely correlated or were improved. Two patients in Group 2 were reintubated due to hypercapnia. All patients in Group 1 and 2 seemed more comfortable on Vapotherm and had fewer traumas to the nose when compared to nCPAP.

Group1:

Extubation to nCPAP followed by Vapotherm

Gest age Wt (kg) nCPAP Vapotherm ABG
27 week 0.57 kg 6 at 21-30% 4 L/min Improved
26 week 0.80 kg 5 at 29-40% 4 L/min Improved
25 week 0.71 kg 5 at 21-30% 3 L/min Same
26 week 0.73 kg 5 at 35-50% 4 L/min Same
28 week 0.90 kg 5/6 at 30% 4-6 L/min Improved

Group 2: Extubated Directly to Vapotherm

Gest age Wt (kg) Vapotherm ABG Weaned to NC
25 week 0.76 4 L/min at 32% Same Yes
28 week 1.25 4 L/min at 24% Improved Yes
26 week 1.02 4 L/min at 40% Not Improved No
25 week 0.58 6 L/min at 28% Same Yes
26 week 0.71 4 L/min at 30% Improved Yes
24 week 0.52 3 L/min at 35% Same No

Discussion: Vapotherm utilizes an open flow system (NC does not seal the nares) to provide respiratory assistance compared to closed system of nCPAP (prongs seal nares). Although, Vapotherm does not set a pressure adequate oxygenation is achieved at flow rated 3-6 L/min in this study. The Vapotherm nasal cannula is applied in similar fashion to standard NC and seems to create less stress to the premature infant.

Conclusion:
The high flow nasal cannula is as effective for oxygenation purposes as nCPAP. Moreover, patients seem more comfortable and there are fewer traumas than nCPAP.

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