High flow nasal heliox improves work of breathing and attenuates lung injury in a newborn porcine lung injury model

Article type: Research Article

Authors: Jassar, R.K.^{a; c; *} | Vellanki, H.^{a; c} | Zhu, Yan^b | Hesek, A.M.^b | Wang, J.^b | Rodriguez, E.^{b; f} | Wolfson, M.R.^e | Shaffer, T.H.^{b; d}

Affiliations: [a] Neonatology, Alfred I. duPont Hospital for Children, Wilmington, DE, USA | [b] Alfred I. duPont Hospital for Children, Center for Pediatric Lung Research, Wilmington, DE, USA | [c] Neonatology, Thomas Jefferson University Hospital, Philadelphia, PA, USA | [d] Temple University School of Medicine, Department of Physiology and Pediatrics, Philadelphia, PA, USA | [e] Temple University School of Medicine, Departments of Physiology, Pediatrics, and Medicine, Center for Inflammation, Translational and Clinical Lung Research, Philadelphia, PA, USA | [f] Nemours Biomedical Research, Alfred I. duPont Hospital for Children, Wilmington, DE, USA

Correspondence: [*] Corresponding author: Romal K. Jassar, MD, Division of Neonatology, Nemours, Alfred I. duPont Hospital for Children, 1600 Rockland Road, Wilmington, DE 19803, USA. Tel.: +1 302 651 4984; Fax: +1 302 651 5458; [email protected]

Abstract: BACKGROUND:High flow nasal cannula (HFNC) has been shown to improve ventilation and oxygenation and reduce work of breathing in newborns with respiratory distress. Heliox, decreases resistance to airflow, reduces the work of breathing, facilitates the distribution of inspired gas, and has been shown to attenuate lung inflammation during the treatment of acute lung injury. HYPOTHESIS:Heliox delivered by HFNC will decrease resistive load, decrease work of breathing, improve ventilation and attenuate lung inflammation during spontaneous breathing following acute lung injury in the newborn pig. METHODS:Spontaneously breathing neonatal pigs received Nitrox or Heliox by HFNC and studied over 4 hrs following oleic acid injury. Gas exchange, pulmonary mechanics and systemic inflammation were measured serially. Lung inflammation biomarkers were assessed at termination. RESULTS:Heliox breathing animals demonstrated lower work of breathing reflected by lower tracheal pressure, phase angle and phase relationship. Ventilation efficiency index was greater compared to Nitrox. Heliox group showed less lung inflammation reflected by lower tissue interleukin-6 and 8. CONCLUSION:High flow nasal Heliox decreased respiratory load, reduced resistive work of breathing indices and attenuated lung inflammatory profile while ventilation was supported at less pressure effort in the presence of acute lung injury.

Keywords: High flow nasal cannula (HFNC), Helium-oxygen (Heliox), lung injury

DOI: 10.3233/NPM-15915039

Journal: Journal of Neonatal-Perinatal Medicine, vol. 8, no. 4, pp. 323-331, 2015