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.
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.