Comparative Study of the Effects of Continuous Positive Airway Pressure and Nasal High-Flow Therapy on Diaphragmatic Dimensions in Preterm Infants

Mohamed El-Mogy; Hanan El-Halaby; Gehan Attia; Hesham Abdel-Hady

doi:10.1055/s-0037-1608682

American Journal of Perinatology, Inhaltsverzeichnis

Am J Perinatol 2018; 35(05): 448-454
DOI: 10.1055/s-0037-1608682

Original Article

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Comparative Study of the Effects of Continuous Positive Airway Pressure and Nasal High-Flow Therapy on Diaphragmatic Dimensions in Preterm Infants

Authors

Mohamed El-Mogy

¹Neonatal Intensive Care Unit, Department of Pediatrics, Mansoura University Children's Hospital, Mansoura, Egypt
Hanan El-Halaby

²Department of Pediatrics, Faculty of Medicine, University of Mansoura, Mansoura, Egypt
Gehan Attia

²Department of Pediatrics, Faculty of Medicine, University of Mansoura, Mansoura, Egypt
Hesham Abdel-Hady

¹Neonatal Intensive Care Unit, Department of Pediatrics, Mansoura University Children's Hospital, Mansoura, Egypt

²Department of Pediatrics, Faculty of Medicine, University of Mansoura, Mansoura, Egypt

Abstract

Objective Nasal continuous positive airway pressure (nCPAP) and nasal high-flow therapy (nHFT) are the most common forms of noninvasive respiratory support in preterm infants. We conducted this study to compare effects of nCPAP and nHFT on diaphragmatic dimensions as assessed by bedside ultrasonography in preterm infants.

Study Design A prospective, randomized crossover study comprised 24 preterm infants. Group 1 (n = 12): started on nCPAP for 60 minutes and then switched to nHFT for 60 minutes. Group 2 (n = 12): started on nHFT for 60 minutes then switched to nCPAP for 60 minutes. Ultrasonographic assessment of diaphragmatic dimensions was performed at the end of each epoch.

Results There were no statistically significant differences in diaphragmatic dimensions at the end of each epoch of nCPAP or nHFT. The diaphragm thickening fraction (DTF) was not significantly different with either nCPAP or nHFT [23.4 (13.7–28.0) versus 23.4 (11.2–31.6), p = 0.57]. No significant differences were found regarding heart rate, respiratory rate, Silverman–Anderson scores, and SpO₂ on nCPAP and nHFT. All infants enrolled tolerated the crossover maneuver.

Conclusion Stable preterm infants (30.3 ± 2.2 weeks' gestation) with mild respiratory dysfunction show comparable effects on diaphragm thickness and excursion during relatively brief periods of support on nCPAP or nHFT.

Clinical Trial Registration Registry name: Clinical Trials.gov. Registration number: NCT02421328. Web link to study on registry: https://clinicaltrials.gov/ct2/show/NCT02421328.

Keywords

CPAP - nHFT - preterm - diaphragm - ultrasound

Volltext

Referenzen

References
1 Jensen EA, Kirpalani H. Non-invasive respiratory support. Semin Fetal Neonatal Med 2016; 21 (03) 133-134
2 Shaffer TH, Alapati D, Greenspan JS, Wolfson MR. Neonatal non-invasive respiratory support: physiological implications. Pediatr Pulmonol 2012; 47 (09) 837-847
3 Mardegan V, Priante E, Lolli E, Lago P, Baraldi E. Heated, humidified high-flow nasal cannulae as a form of noninvasive respiratory support for preterm infants and children with acute respiratory failure. Am J Perinatol 2016; 33 (11) 1058-1061
4 Ojha S, Gridley E, Dorling J. Use of heated humidified high-flow nasal cannula oxygen in neonates: a UK wide survey. Acta Paediatr 2013; 102 (03) 249-253
5 Hepping N, Garbe W, Schneider K. High-flow nasal cannulae (HFNC) in neonates: a survey of current practice in level 1 perinatal centres in the German state of North Rhine-Westphalia. Z Geburtshilfe Neonatol 2015; 219 (06) 253-258
6 Motojima Y, Ito M, Oka S, Uchiyama A, Tamura M, Namba F. Use of high-flow nasal cannula in neonates: nationwide survey in Japan. Pediatr Int 2016; 58 (04) 308-310
7 Roberts CT, Owen LS, Manley BJ, Davis PG. ; Australian & New Zealand Neonatal Network (ANZNN). High-flow support in very preterm infants in Australia and New Zealand. Arch Dis Child Fetal Neonatal Ed 2016; 101 (05) F401-F403
8 Yoder BA, Manley B, Collins C. , et al. Consensus approach to nasal high-flow therapy in neonates. J Perinatol 2017; 37 (07) 809-813
9 Osman M, Elsharkawy A, Abdel-Hady H. Assessment of pain during application of nasal-continuous positive airway pressure and heated, humidified high-flow nasal cannulae in preterm infants. J Perinatol 2015; 35 (04) 263-267
10 Wilkinson D, Andersen C, O'Donnell CP, De Paoli AG, Manley BJ. High flow nasal cannula for respiratory support in preterm infants. Cochrane Database Syst Rev 2016; 2: CD006405
11 Saslow JG, Aghai ZH, Nakhla TA. , et al. Work of breathing using high-flow nasal cannula in preterm infants. J Perinatol 2006; 26 (08) 476-480
12 Frizzola M, Miller TL, Rodriguez ME. , et al. High-flow nasal cannula: impact on oxygenation and ventilation in an acute lung injury model. Pediatr Pulmonol 2011; 46 (01) 67-74
13 Dysart K, Miller TL, Wolfson MR, Shaffer TH. Research in high flow therapy: mechanisms of action. Respir Med 2009; 103 (10) 1400-1405
14 Kotecha SJ, Adappa R, Gupta N, Watkins WJ, Kotecha S, Chakraborty M. Safety and efficacy of high-flow nasal cannula therapy in preterm infants: a meta-analysis. Pediatrics 2015; 136 (03) 542-553
15 Wilkinson DJ, Andersen CC, Smith K, Holberton J. Pharyngeal pressure with high-flow nasal cannulae in premature infants. J Perinatol 2008; 28 (01) 42-47
16 Chen SW, Fu W, Liu J, Wang Y. Routine application of lung ultrasonography in the neonatal intensive care unit. Medicine (Baltimore) 2017; 96 (02) e5826
17 Zambon M, Greco M, Bocchino S, Cabrini L, Beccaria PF, Zangrillo A. Assessment of diaphragmatic dysfunction in the critically ill patient with ultrasound: a systematic review. Intensive Care Med 2017; 43 (01) 29-38
18 Boussuges A, Gole Y, Blanc P. Diaphragmatic motion studied by M-mode ultrasonography: methods, reproducibility, and normal values. Chest 2009; 135 (02) 391-400
19 Umbrello M, Formenti P, Longhi D. , et al. Diaphragm ultrasound as indicator of respiratory effort in critically ill patients undergoing assisted mechanical ventilation: a pilot clinical study. Crit Care 2015; 19: 161
20 Vivier E, Mekontso Dessap A, Dimassi S. , et al. Diaphragm ultrasonography to estimate the work of breathing during non-invasive ventilation. Intensive Care Med 2012; 38 (05) 796-803
21 DiNino E, Gartman EJ, Sethi JM, McCool FD. Diaphragm ultrasound as a predictor of successful extubation from mechanical ventilation. Thorax 2014; 69 (05) 423-427
22 Rehan VK, Laiprasert J, Nakashima JM, Wallach M, McCool FD. Effects of continuous positive airway pressure on diaphragm dimensions in preterm infants. J Perinatol 2001; 21 (08) 521-524
23 Silverman WA, Andersen DH. A controlled clinical trial of effects of water mist on obstructive respiratory signs, death rate and necropsy findings among premature infants. Pediatrics 1956; 17 (01) 1-10
24 Rehan VK, Laiprasert J, Wallach M, Rubin LP, McCool FD. Diaphragm dimensions of the healthy preterm infant. Pediatrics 2001; 108 (05) E91
25 El-Halaby H, Abdel-Hady H, Alsawah G, Abdelrahman A, El-Tahan H. Sonographic evaluation of diaphragmatic excursion and thickness in healthy infants and children. J Ultrasound Med 2016; 35 (01) 167-175
26 Goligher EC, Laghi F, Detsky ME. , et al. Measuring diaphragm thickness with ultrasound in mechanically ventilated patients: feasibility, reproducibility and validity. Intensive Care Med 2015; 41 (04) 734
27 Lavizzari A, Veneroni C, Colnaghi M. , et al. Respiratory mechanics during NCPAP and HHHFNC at equal distending pressures. Arch Dis Child Fetal Neonatal Ed 2014; 99 (04) F315-F320
28 Shetty S, Hickey A, Rafferty GF, Peacock JL, Greenough A. Work of breathing during CPAP and heated humidified high-flow nasal cannula. Arch Dis Child Fetal Neonatal Ed 2016; 101 (05) F404-F407
29 de Jongh BE, Locke R, Mackley A. , et al. Work of breathing indices in infants with respiratory insufficiency receiving high-flow nasal cannula and nasal continuous positive airway pressure. J Perinatol 2014; 34 (01) 27-32
30 Nasef N, El-Gouhary E, Schurr P. , et al. High-flow nasal cannulae are associated with increased diaphragm activation compared with nasal continuous positive airway pressure in preterm infants. Acta Paediatr 2015; 104 (08) e337-e343
31 de Waal CG, Hutten GJ, Kraaijenga JV, de Jongh FH, van Kaam AH. Electrical activity of the diaphragm during nCPAP and high flow nasal cannula. Arch Dis Child Fetal Neonatal Ed 2017; 102 (05) F434-F438
32 Courtney SE, Pyon KH, Saslow JG, Arnold GK, Pandit PB, Habib RH. Lung recruitment and breathing pattern during variable versus continuous flow nasal continuous positive airway pressure in premature infants: an evaluation of three devices. Pediatrics 2001; 107 (02) 304-308
33 Ignacio L, Alfaleh K. High-flow nasal cannulae in very preterm infants after extubation. J Clin Neonatol 2014; 3 (01) 11-13
34 Hegde D, Mondkar J, Panchal H, Manerkar S, Jasani B, Kabra N. Heated humidified high flow nasal cannula versus nasal continuous positive airway pressure as primary mode of respiratory support for respiratory distress in preterm infants. Indian Pediatr 2016; 53 (02) 129-133
35 Roberts CT, Owen LS, Manley BJ. , et al; HIPSTER Trial Investigators. Nasal high-flow therapy for primary respiratory support in preterm infants. N Engl J Med 2016; 375 (12) 1142-1151
36 Taha DK, Kornhauser M, Greenspan JS, Dysart KC, Aghai ZH. High flow nasal cannula use is associated with increased morbidity and length of hospitalization in extremely low birth weight infants. J Pediatr 2016; 173: 50-55