The Science Journal of the American Association for Respiratory Care

2011 OPEN FORUM Abstracts


Aprille Febre, Mitchell Goldstein, T Allen Merritt, Michael Terry, Carter Tong, Elba Fayard, Ricardo Peverini; Neonatology, Loma Linda University Children's Hospital, Loma Linda, CA

Background: The use of high flow nasal cannula has increased dramatically in the neonatal intensive care setting. High flow nasal cannula (HFNC) simulates a continuous positive airway pressure despite unpredictable leak by way of using a higher flow to "overwhelm" the resistive capacity of the nares and create a NCPAP like effect. There is no absolute way to assure that the transmitted pressures do not exceed what might be considered a safe range for the neonate. The ADINA introduces an additional safety mechanism designed to adaptively restrict the amount of pressure that can be delivered to the nasal interface. Although flows can be entrained up to 4 lpm, airway pressure is limited by an adaptive pop off valve set at 10 cm H20. Even if the pop off mechanism were to fail to actuate, the device would continue to provide high flow nasal cannula delivery at levels that are already in wide clinical use. Methods: Patients were randomized to receive either "standard" nasal CPAP with Hudson prongs or high flow nasal cannula with the ADINA (Adaptive Dynamic Inspiratory Nasal Apparatus). Hudson prongs NCPAP pressure was started at 4-8 cm H2O. High flow nasal cannula was started at 2-4 lpm of flow. Oxygen requirement, level of pressure or flow support, radiological changes, blood gases measurement, time to wean off protocol, and failure to wean/necessity for endotracheal intubation were monitored. 19 subjects were enrolled. Objectives: 1. Real-Time device actuation - Can high flow nasal cannula be delivered with a pop off that actuates in real time? 2. Comfort of interface - Can this Novel device provide a high flow nasal cannula effect simulating CPAP at the same comfort levels as those provided by conventional nasal cannula? Results: See table below. There were two parents who refused consent out of concern that their child would randomize to CPAP. Discussion: Although there was a significant difference apparent in days on ADINA versus NCPAP (p < 0.01) (9.8 +/- 8.6 v. 1.4 +/-0.7), a significant bias towards the ADINA cannula was evident (both towards selection and continuation). No patient failed within a week of starting ADINA, although several patient failed to tolerate NCPAP. Patients randomized to ADINA trended towards lower BW and PCA at time of study. No complications of air leak, hypotension, or barotraumas were evident in either group. Conclusion: ADINA appears to be at equivalent to NCPAP in providing non-invasive ventilation.
Sponsored Research - Neotech provided the ADINA cannulae for the study.