Source: International Congress 2016 – Origins of infant pulmonary disease: early pointers for identifying infants at risk and ways to improve their care
Disease area: Paediatric lung diseases, Respiratory critical care

Abstract

Background: Clinical studies in adults revealed that mouth leaks impair gas conditioning during CPAP. However, similar data is lacking for neonates.Aims and Objectives: This study used a novel bench model to investigate the impact of mouth leaks on oropharyngeal temperature and humidity during neonatal CPAP.Methods: Oropharyngeal air conditions during spontaneous breathing were simulated by insertion of a heated humidifier between an oropharyngeal head model and an active lung model. Oropharyngeal temperature (T), relative humidity (RH) and absolute humidity (AH) were measured using a digital thermohygrosensor. First, the influence of mouth leak was assessed during unsupported spontaneous breathing. Next, the impact of mouth leak was investigated during binasal CPAP using three different scenarios: no conditioning in the CPAP circuit, heating only, and heated humidification.Results: Without CPAP, mouth leaks had no significant effect on T, RH, and AH. With a constant respiratory rate of 60/min and an occluded "mouth", T was 32.1±0.2°C and AH was 33.7±0.6 g/m³. During CPAP, the impact of mouth leaks was significant. Without gas conditioning, AH decreased from 23.2±2.0 g/m³ with an occluded "mouth" to 3.0±0.3 g/m³ with a mouth leak (p <0.001), and with heating alone, from 20.3±2.8 g/m³ to 4.3 ±0.3 g/m³ (p <0.001). With heated humidification, AH was 42.6±0.9 g/m³ with an occluded "mouth" and 35.7±1.9 g/m³ with a mouth leak (p <0.001).Conclusions: During CPAP, mouth leaks impaired oropharyngeal gas conditioning in all tested scenarios, but heated humidification maintained clinically acceptable humidity levels.


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Citations should be made in the following way:
Hendrik Fischer (Berlin, Germany), Hendrik Fischer, Tim Ullrich, Christoph Bührer, Christoph Czernik, Gerd Schmalisch. Impact of mouth leak on oropharyngeal gas conditioning during neonatal CPAP: A bench study. Eur Respir J 2016; 48: Suppl. 60, 246

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