Comparison of the pharyngeal pressure provided by two heated, humidified high-flow nasal cannulae devices in premature infants

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Aims:This study aims to determine if there is a difference in the pharyngeal pressure, measured as a surrogate for continuous positive distending airway pressure, delivered to premature infants between two commonly used heated, humidified high-flow nasal cannulae (HHHFNC) devices: Fisher & Paykel Healthcare HHHFNC and Vapotherm 2000i.Methods:Pharyngeal pressure measurements were taken from stable premature infants receiving HHHFNC for respiratory support. Flow rates of 2–8 L/min were studied.Results:Nine infants had pharyngeal pressure measurements recorded with both HHHFNC devices at flow rates of 2–8 L/min. There was no difference in pharyngeal pressures recorded between devices at flow rates of 2–6 L/min; measured pressure was linearly associated with flow (R2 = 0.9). At flow rates of 7 L/min, Vapotherm delivered a mean (standard deviation) pharyngeal pressure of 4.7 (2.2) cmH2O compared with 4.23 (2.2) cmH2O by the Fisher & Paykel device (P = 0.04). At a flow of 8 L/min, the mean pharyngeal pressure via Vapotherm was 4.9 (2.2) cmH2O compared with 4.1 (2.3) cmH2O with the Fisher & Paykel device (P = 0.05).Conclusions:Both HHHFNC delivered similar pharyngeal pressures at flow rates of 2–6 L/min. The pressure limiter valve of the Fisher & Paykel device attenuated the pharyngeal pressures at flows of 7 and 8 L/min. Vapotherm trended towards higher delivered pharyngeal pressure at flow rates 7 and 8 L/min, but the clinical significance of the difference remains unclear.

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