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- Title
PRESSURE RELIEF VALVE INFLUENCE ON WESTMED HIGH FLOW NASAL CANNULA FLOW DELIVERY.
- Authors
Warnecke, Edna L.; Pirracchio, Romain; DiBlasi, Robert M.
- Abstract
Background: The neonatal nasal cannula (NC) has high resistance to flow which may result in increased circuit pressures during Humidified High Flow NC administration. The Westmed Pressure Safe neonatal NC™ (Westmed, Inc, Tucson, AZ) has a variable pressure relief valve (PRV; 16-21 cmH2O) and was tested with three circuit configurations containing two different PRVs. We hypothesized that presence of a PRV incorporated in either the NC or circuit would limit pressure with consequent reduction in flow delivered distal to the NC. Methods: The NC was first attached to an infant circuit containing a 40 +/- 5 cmH20 PRV (RT329; Fisher & Paykel Healthcare, Ltd, Auckland, New Zealand). Gas was supplied to the circuit via a standard flowmeter at flows of 1-10 L/min. Four sets of the following measurements were obtained via the FlowAnalyzer™ PF 300 (intmedical, Buchs, Switzerland): 1) flow from the NC (delivered flow) and circuit (set flow) and 2) pressure of the NC and circuit. These measurements were then obtained with the PRV removed from the RT329 circuit at flows of 2, 4, 6, 8 and 10 L/min and with the Hudson RCI® Comfort Flo® circuit incorporating a 352 cmH2O PRV (Teleflex Medical, Wayne, PA). The proportion of flow lost (set flow - delivered flow / set flow) was modeled using a single-way ANOVA with circuit type, set flow and the interaction between the two. Analyses were performed using R 3.1.0 software (R Core team, The R Foundation for Statistical Computing, Vienna, Austria). Results: Flow loss was significantly associated with circuit type (p<0.001) and set flow (p<0.001). The Pressure Safe™ NC combined with the circuit including a 40 +/-5 5cmH2O PRV was associated with greater flow loss as compared to the other circuits (p<0.001), reaching a loss of 40.1% at 10 L/min (Fig. 1). During maximal flow loss, pressure measured at the NC approached 8 cmH2O, while the pressure in the RT329 circuit proximal to the PRV reached a mean of 40 cmH2O. Conclusions: As circuit pressures reached the RT329 PRV setting, delivered flow through the Westmed NC was significantly reduced. Flow was unaffected when the PRV was taken out or when connected to the Hudson RCI® circuit containing a higher PRV. The pressure within the Pressure Safe™ NC never reached its integrated PRV level. Clinicians should understand the impact of a PRV on delivered flow when using a neonatal High Flow NC in order to assure delivery of intended flow. Sponsored Research - Circuits were obtained from both Fisher & Paykel Healthcare and Teleflex Medical.
- Subjects
PEDIATRICS; NASAL cannula
- Publication
Respiratory Care, 2016, Vol 61, Issue 10, pOF43
- ISSN
0020-1324
- Publication type
Article