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Mechanistic Understanding of High Flow Nasal Cannula Therapy and Pressure Support with an In Vitro Infant Model

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Abstract

Despite the increased use of high flow nasal cannula therapy, little has been done to predict airway pressures for a full breath cycle. A 3-month-old infant in vitro model was developed, which included the entire upper airway and the first three bifurcations of the lungs. A breathing simulator was used to create a realistic breath pattern, and high flow was provided using a Vapotherm unit. Four cannulas of varying sizes were used to assess the effects of the inner diameter and nasal occlusion of the cannulas on airway pressures. At 8 L min−1, end expiratory pressures of 0.821–1.306 cm H2O and 0.828–1.133 cm H2O were produced in the nasopharynx and trachea, respectively. Correlations were developed to predict full breath cycle airway pressures, based on the gas flow rate delivered, cannula dimensions, as well as the breathing flow rate, for the nasopharynx and trachea. Pearson correlation coefficients for the nasopharynx and trachea correlations were 0.991 and 0.992, respectively. The developed correlations could be used to determine the flow rate necessary for a cannula to produce pressures similar to CPAP settings. The proposed correlations accurately predict the regional airway pressure up to and including 7 cm H2O of support for the entire breath cycle.

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Acknowledgments

The Radiology Center in VCU Main Hospital is acknowledged for providing the CT images. Amber Clark and Paul Clark are acknowledged for printing the in vitro model and the preliminary experimental setup. Dr. Golshahi acknowledges the funding received from VCU as startup and Presidential Research Quest Fund (PeRQ). Dr. Gardner acknowledges discussions with her Fellowship Committee.

Conflict of interest

The authors have no conflicts of interest to declare related to the subject of this manuscript.

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Authors and Affiliations

  1. Department of Mechanical and Nuclear Engineering, Virginia Commonwealth University, Richmond, VA, USA

    John V. Wilkins Jr., Ross Walenga, Sana Hosseini, P. Worth Longest & Laleh Golshahi

  2. Division of Pediatric Critical Care Medicine, Department of Pediatrics, Children’s Hospital of Richmond, Virginia Commonwealth University, Richmond, VA, USA

    Michelle T. Gardner

  3. Department of Pharmaceutics, Virginia Commonwealth University, Richmond, VA, USA

    P. Worth Longest

  4. Department of Mechanical and Nuclear Engineering, Virginia Commonwealth University, Room 1083, 800 E. Leigh St, Richmond, VA, 23298, USA

    Laleh Golshahi

Authors
  1. John V. Wilkins Jr.
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  2. Michelle T. Gardner
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  4. Sana Hosseini
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Correspondence to Laleh Golshahi.

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Associate Editor Merryn Tawhai oversaw the review of this article.

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Wilkins, J.V., Gardner, M.T., Walenga, R. et al. Mechanistic Understanding of High Flow Nasal Cannula Therapy and Pressure Support with an In Vitro Infant Model. Ann Biomed Eng 48, 624–633 (2020). https://doi.org/10.1007/s10439-019-02377-z

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  • DOI: https://doi.org/10.1007/s10439-019-02377-z

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