In vitro and in vivo analysis of high flow nasal cannulae compared with nasal CPAP for newborns

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Nasal continuous positive airway pressure (CPAP) has been shown to be effective in the treatment of newborn respiratory distress syndrome. However, there can be mechanical difficulties in maintaining a seal with the small newborn nose. Humidified high flow nasal cannulae have been introduced as an alternative method for positive distending pressure. In this issue of The Journal, Lampland et al from Children's Hospital of Minnesota have compared the two approaches both in vitro and in vivo. In vitro they showed that the high flow nasal cannulae system did not tolerate leaks as small as 30%, resulting in a loss of positive pressure. In vivo it showed that after measuring end expiratory pressures on nasal CPAP and then transferring to high flow nasal cannulae, with progressive reduction in flow, that the respiratory rate of the infants increased significantly and end-expiratory pressures became very unstable.

These results are discussed in an editorial by Finer et al from the University of California-San Diego. Finer et al puts these results into perspective and discusses the concerns raised by the results of the study by Lampland et al. Both Lampland et al and Finer et al agree on the need for prospective randomized trials comparing high flow nasal cannulae with better defined methods for delivering CPAP.