Effects of high-flow transnasal insufflation

Effects of high-flow transnasal insufflation compared with cPAP and
spontaneous breathing on pressure amplitude and mean pressure in patients
with IPF and COPD
Bräunlich, J.; Mai, D., Beyer, D.; Hammerschmidt, S.; Seyfarth, H.-J.; Wirtz, H.
Department of Respiratory Medicine, University of Leipzig, 04103 Leipzig, Germany
Introduction: Treatment with high flow transnasal insufflations (TNI©) is able to improve symptoms of chronic
respiratory insufficiency. The method uses a warmed and humified high flow of air/ oxygen with 16-24 L per minute. In
pediatric patients the device was similarly effective compared to non-invasive ventilation with a face mask. An increase
in mean pressure in healthy volunteers has been described. The clinical effects in adults are unknown.1-4
Results: TNI led to an increase in pressure
amplitudes and mean pressure in healthy volunteers
and patients with COPD or IPF in comparison with
spontaneous breathing. CPAP alone showed a
greater effect on mean pressure in all groups. In
summary, transanasal insufflation resulted in an
increase in pressure amplitude and mean pressure in
healthy volunteers and in patients with COPD and
IPF. Blood gas analysis revealed a decrease in pCO2
in patients with IPF and COPD.
Methode: A water-filled tube connected to a sensitive
pressure transducer was used as a sensor. The tube was
placed in the nose, with the patient in supine and prone body
positions. The signal was put out to an analog paper writer.
We measured pressure amplitudes during the respiratory
cycle and mean pressures in patients with IPF and COPD
using TNI and nasal cPAP (4mbar) respectively. We
compared the results with values measured during
spontaneous breathing. The capillary blood gas analysis was
taking from the hyperemic earlap.
mean pressure/ COPD/ supine/ nose n=15
pressure amplitude/ COPD/ supine/ nose n=15
5,9
9,5
4,2
pCO2 in COPD n=6
9,0
5,1
8,5
pCO2 kPa
3,4
4,2
3,4
2,5
2,5
1,7
1,7
7,5
7,0
6,5
mbar
0,9
mbar
8,0
0
0,9
6,0
SA
spontaneous breathing
TNI
p<0,0009
p<0,009
p<0,006
5,5
TNI
CPAP
Time
mean pressure/ IPF/ supine/ nose n=13
pressure amplitude/ IPF/ supine/ nose n=13
8h
0h
CPAP
p<0,002
10
4,2
pCO2 in IPF n=8
9
3,4
3,4
8
1,7
pCO2 kPa
2,5
2,5
1,7
6
mbar
0,9
mbar
7
0
0,9
5
-0,9
4
spontaeous breathing
TNI
p<0,05
CPAP
p>0,06
SA
TNI
p<0,05
CPAP
p<0,05
0h
8h
Time
Discussion: Transnasal insufflation resulted in significant effects on respiratory parameters in patients with obstructive
and restrictive pulmonary diseases. The rise in pressure amplitude and mean pressure will support inspiratory efforts,
may increase ventiliation and will contribute to a reduction in the work of breathing. A CO2 wash-out of the upper airway
part of the anatomical dead space may contribute to the beneficial effects of the TNI instrument.
1 McGinley et al. (2007): A nasal cannula can be used to treat obstructive sleep apnoe. 2 Chatila et al. (2004): The effects of High-flow vs. Low-Flow oxygen in exercise in
advanced obstructive airway disease. 3 Sreenan et al. (2001): High-flow nasal cannulae in the management of apnea of prematurity: a comparison with conventional nasal
continuous positive airway pressure. 4 Groves N, Tobin A. (2007): High flow nasal oxygen generates positive airway pressure in adult volunteers.