A novel in-line high frequency interrupter for use with bubble CPAP: A feasibility study in a premature lamb model

Article type: Research Article

Authors: Sivieri, E.M.^{a; b; *} | Eichenwald, E.C.^{a; b; c} | Abbasi, S.^{a; b; c} | Wolfson, M.R.^d

Affiliations: [a] Children’s Hospital of Philadelphia Newborn Care at Pennsylvania Hospital, Philadelphia, PA, USA | [b] Division of Neonatology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA | [c] Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA | [d] Department of Physiology, Department of Pediatrics, Department of Thoracic Medicine and Surgery, Temple Lung Center, Center for Translational Medicine, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, USA

Correspondence: [*] Address for correspondence: Emidio M. Sivieri, CHOP Newborn Care at Pennsylvania Hospital, 800 Spruce Street, Philadelphia, PA 19107, USA. Tel.: +1 215 829 3301; Fax: +1 215 829 7211; E-mail: emidio.sivieri@pennmedicine.upenn.edu.

Abstract: BACKGROUND:Recent in vitro testing of high frequency (HF) oscillation applied to bubble continuous positive airway pressure (BCPAP) using a novel flow interrupter device (HFI) demonstrated significantly improved CO2 washout while not altering delivered mean airway pressure (MAP) in a premature infant lung model. This study’s aim was to evaluate the safety and efficacy of the HFI paired with BCPAP in an animal model of prematurity prior to clinical testing. DESIGN/METHODS:Twelve fetal lambs, 131–135 days gestation, weight 3.51±0.42 kg, were delivered by Cesarean section. The lambs were supported by mechanical ventilation and weaned to spontaneous breathing with BCPAP at 6 cmH2O. A combined CO2/airflow sensor measured end-tidal (EtCO2) and tidal volume (VT). Blood gases, heart rate (HR), arterial pressure (Part), minute ventilation (MV), MAP, ventilatory efficiency index (VEI), thoracoabdominal phase angle and labored breathing index (LBI) were recorded over a 10-minute baseline period followed by four randomized 10-minute intervals with HFI set to either 8, 10, 12 or 15 Hz. RESULTS:EtCO2 decreased from baseline by 11.1±2.2SE%, 16.6±4.3SE%, 13.5±4.9SE%, and 19.5±4.5SE% at 8, 10, 12, and 15 Hz respectively (p < 0.001). Blood gases, SpO2, HR, Part, MAP, VT, MV, esophageal pressure, phase angle, and LBI underwent no significant change with HF. Respiratory rate decreased, and VEI increased, by 14.9±4.5SD% (p = 0.037) and 83±22SD% (p < 0.011) respectively, averaged over all frequencies. CONCLUSIONS:We demonstrated the safety and efficacy of a novel BCPAP flow interrupter device. HF applied to the respiratory system resulted in significantly improved CO2 clearance and ventilation efficiency with no deleterious physiological effects in a pre-term lamb model.

Keywords: Bubble CPAP, carbon dioxide clearance, high frequency oscillation, non-invasive ventilation

DOI: 10.3233/NPM-210899

Journal: Journal of Neonatal-Perinatal Medicine, vol. 15, no. 2, pp. 257-263, 2022