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First, in a test lung simulating spontaneous breathing, we found that the modified HFT caused an elevation in airway pressure as a power function of flow. Then, three tracheal oxygen treatments (T-piece oxygen at 10\u2009L\/min, HFT and modified HFT at 40\u2009L\/min) were delivered in a random crossover fashion to six tracheostomized pigs before and after the induction of lung injury. The modified HFT induced a significantly higher airway pressure compared with that in either T-piece or HFT (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001). Expiratory resistance significantly increased during modified HFT (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.05) to a mean value of 4.9 to 6.7\u2009cm H<jats:sub>2<\/jats:sub>O\/L\/s. The modified HFT induced significant augmentation in end-expiratory lung volume (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.05) and improved oxygenation for lung injury model (<jats:italic>p<\/jats:italic>\u2009=\u20090.038) compared with the HFT and T-piece. There was no significant difference in esophageal pressure swings, transpulmonary driving pressure or pressure time product among the three treatments (<jats:italic>p<\/jats:italic>\u2009&gt;\u20090.05). In conclusion, the modified HFT with additional expiratory resistance generated a clinically relevant elevation in airway pressure and lung volume. Although expiratory resistance increased, inspiratory effort, lung stress and work of breathing remained within an acceptable range.<\/jats:p>","DOI":"10.1038\/s41598-019-51158-0","type":"journal-article","created":{"date-parts":[[2019,10,10]],"date-time":"2019-10-10T10:32:32Z","timestamp":1570703552000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Additional Expiratory Resistance Elevates Airway Pressure and Lung Volume during High-Flow Tracheal Oxygen via Tracheostomy"],"prefix":"10.1038","volume":"9","author":[{"given":"Guang-Qiang","family":"Chen","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiu-Mei","family":"Sun","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yu-Mei","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yi-Min","family":"Zhou","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jing-Ran","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kun-Ming","family":"Cheng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yan-Lin","family":"Yang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jian-Xin","family":"Zhou","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2019,10,10]]},"reference":[{"key":"51158_CR1","doi-asserted-by":"publisher","first-page":"459","DOI":"10.1164\/ajrccm.156.2.9610109","volume":"156","author":"A Esteban","year":"1997","unstructured":"Esteban, A. et al. 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The sponsor had no role in the study design, data collection, data analysis, data interpretation, or writing of the report. G.Q.C., X.M.S. and J.X.Z. have applied for a patent on the modified interface of high-flow tracheal oxygen via tracheostomy interface that has been already granted by the national intellectual property administration in China (ZL201721110635.2). Other authors declare that they have no competing interest.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing Interests"}}],"article-number":"14542"}}