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

J Paediatr Child Health. 2013 Jul;49(7):554-6. doi: 10.1111/jpc.12277. Epub 2013 Jun 18.


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 (R(2) = 0.9). At flow rates of 7 L/min, Vapotherm delivered a mean (standard deviation) pharyngeal pressure of 4.7 (2.2) cmH2 O compared with 4.23 (2.2) cmH2 O 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) cmH2 O compared with 4.1 (2.3) cmH2 O 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.

Keywords: continuous positive airway pressure; heated; humidified high-flow nasal cannula; infant; non-invasive ventilation; premature.

Publication types

  • Comparative Study
  • Randomized Controlled Trial

MeSH terms

  • Catheters
  • Continuous Positive Airway Pressure / instrumentation*
  • Female
  • Heating
  • Humans
  • Humidity
  • Infant, Newborn
  • Infant, Premature*
  • Male
  • Pharynx*
  • Pressure