{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,26]],"date-time":"2026-10-26T17:01:26Z","timestamp":1793034086260,"version":"4.5.0"},"reference-count":16,"publisher":"American Academy of Pediatrics (AAP)","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2008,1,1]]},"abstract":"<jats:p>OBJECTIVE. The goal was to estimate the level of delivered continuous positive airway pressure by measuring oral cavity pressure with the mouth closed in infants of various weights and ages treated with heated, humidified high-flow nasal cannula at flow rates of 1\u20135 L\/minute. We hypothesized that clinically relevant levels of continuous positive airway pressure would not be achieved if a nasal leak is maintained.<\/jats:p><jats:p>METHODS. After performing bench measurements and demonstrating that oral cavity pressure closely approximated levels of traditionally applied nasal continuous positive airway pressure, we successfully measured oral cavity pressure during heated, humidified, high-flow nasal cannula treatment in 27 infants. Small (outer diameter: 0.2 cm) cannulae were used for all infants, and flow rates were left as ordered by providers.<\/jats:p><jats:p>RESULTS. Bench measurements showed that, for any given leak size, there was a nearly linear relationship between flow rate and pressure. The highest pressure achieved was 4.5 cmH2O (flow rate: 8 L\/minute; leak: 3 mm). In our study infants (postmenstrual age: 29.1\u201344.7 weeks; weight: 835\u20133735 g; flow rate: 1\u20135 L\/minute), no pressure was generated with the mouth open at any flow rate. With the mouth closed, the oral cavity pressure was related to both flow rate and weight. For infants of \u22641500 g, there was a linear relationship between flow rate and oral cavity pressure.<\/jats:p><jats:p>CONCLUSIONS. Oral cavity pressure can estimate the level of continuous positive airway pressure. Continuous positive airway pressure generated with heated, humidified, high-flow nasal cannula treatment depends on the flow rate and weight. Only in the smallest infants with the highest flow rates, with the mouth fully closed, can clinically significant but unpredictable levels of continuous positive airway pressure be achieved. We conclude that heated, humidified high-flow nasal cannula should not be used as a replacement for delivering continuous positive airway pressure.<\/jats:p>","DOI":"10.1542\/peds.2007-0957","type":"journal-article","created":{"date-parts":[[2007,12,31]],"date-time":"2007-12-31T17:23:13Z","timestamp":1199121793000},"page":"82-88","source":"Crossref","is-referenced-by-count":216,"title":["Heated, Humidified High-Flow Nasal Cannula Therapy: Yet Another Way to Deliver Continuous Positive Airway Pressure?"],"prefix":"10.1542","volume":"121","author":[{"given":"Zuzanna J.","family":"Kubicka","sequence":"first","affiliation":[{"name":"Departments of Pediatrics"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph","family":"Limauro","sequence":"additional","affiliation":[{"name":"Respiratory Therapy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert A.","family":"Darnall","sequence":"additional","affiliation":[{"name":"Departments of Pediatrics"},{"name":"Physiology, Dartmouth Medical School and Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"417","published-online":{"date-parts":[[2008,1,1]]},"reference":[{"key":"2021120902202448000_R1","doi-asserted-by":"crossref","unstructured":"Goldsmith JP, Karotkin EH. Continuous positive airway pressure. In: Goldsmith JP, Karotkin EH, eds. Assisted Ventilation of the Neonate. 4th ed. Philadelphia, PA: Saunders; 2003:127\u2013147","DOI":"10.1016\/B978-0-7216-9296-8.50013-1"},{"key":"2021120902202448000_R2","doi-asserted-by":"crossref","unstructured":"Polin RA, Sahni R. Newer experience with CPAP. Semin Neonatol.\u20082002;7:379\u2013389","DOI":"10.1053\/siny.2002.0132"},{"key":"2021120902202448000_R3","doi-asserted-by":"crossref","unstructured":"Finer NN. Nasal cannula use in the preterm infant: oxygen or pressure?Pediatrics.\u20082005;116:1216\u20131217","DOI":"10.1542\/peds.2005-1741"},{"key":"2021120902202448000_R4","doi-asserted-by":"crossref","unstructured":"Sreenan C, Lemke RP, Hudson-Mason A, Osiovich H. High-flow nasal cannulae in the management of apnea of prematurity: a comparison with conventional nasal continuous positive airway pressure. Pediatrics.\u20082001;107:1081\u20131083","DOI":"10.1542\/peds.107.5.1081"},{"key":"2021120902202448000_R5","doi-asserted-by":"crossref","unstructured":"Locke RG, Wolfson MR, Shaffer TH, Rubenstein SD, Greenspan JS. Inadvertent administration of positive end-distending pressure during nasal cannula flow. Pediatrics.\u20081993;91:135\u2013138","DOI":"10.1542\/peds.91.1.135"},{"key":"2021120902202448000_R6","doi-asserted-by":"crossref","unstructured":"Kopelman AE, Holbert D. Use of oxygen cannulas in extremely low birthweight infants is associated with mucosal trauma and bleeding, and possibly with coagulase-negative staphylococcal sepsis. J Perinatol.\u20082003;23:94\u201397","DOI":"10.1038\/sj.jp.7210865"},{"key":"2021120902202448000_R7","unstructured":"Waugh JB, Granger WM. An evaluation of 2 new devices for nasal high-flow gas therapy. Respir Care.\u20082004;49:902\u2013906"},{"key":"2021120902202448000_R8","doi-asserted-by":"crossref","unstructured":"Rathgeber J, Kazmaier S, Penack O, Zuchner K. Evaluation of heated humidifiers for use on intubated patients: a comparative study of humidifying efficiency, flow resistance, and alarm functions using a lung model. Intensive Care Med.\u20082002;28:731\u2013739","DOI":"10.1007\/s00134-002-1275-9"},{"key":"2021120902202448000_R9","doi-asserted-by":"crossref","unstructured":"Shoemaker MT, Pierce MR, Yoder BA, DiGeronimo RJ. High flow nasal cannula versus nasal CPAP for neonatal respiratory disease: a retrospective study. J Perinatol.\u20082007;27:85\u201391","DOI":"10.1038\/sj.jp.7211647"},{"key":"2021120902202448000_R10","doi-asserted-by":"crossref","unstructured":"Campbell DM, Shah PS, Shah V, Kelly EN. Nasal continuous positive airway pressure from high flow cannula versus Infant Flow for preterm infants. J Perinatol.\u20082006;26:546\u2013549","DOI":"10.1038\/sj.jp.7211561"},{"key":"2021120902202448000_R11","doi-asserted-by":"crossref","unstructured":"Saslow JG, Aghai ZH, Nakhla TA, et al. Work of breathing using high-flow nasal cannula in preterm infants. J Perinatol.\u20082006;26:476\u2013480","DOI":"10.1038\/sj.jp.7211530"},{"key":"2021120902202448000_R12","doi-asserted-by":"crossref","unstructured":"Schulze A. Respiratory gas conditioning in infants with an artificial airway. Semin Neonatol.\u20082002;7:369\u2013377","DOI":"10.1053\/siny.2002.0131"},{"key":"2021120902202448000_R13","doi-asserted-by":"crossref","unstructured":"Tarnow-Mordi WO, Reid E, Griffiths P, Wilkinson AR. Low inspired gas temperature and respiratory complications in very low birth weight infants. J Pediatr.\u20081989;114:438\u2013442","DOI":"10.1016\/S0022-3476(89)80567-0"},{"key":"2021120902202448000_R14","doi-asserted-by":"crossref","unstructured":"Shelly MP, Lloyd GM, Park GR. A review of the mechanisms and methods of humidification of inspired gases. Intensive Care Med.\u20081988;14:1\u20139","DOI":"10.1007\/BF00254114"},{"key":"2021120902202448000_R15","unstructured":"Centers for Disease Control and Prevention. Ralstonia associated with Vapotherm oxygen delivery device: United States, 2005. MMWR Morb Mortal Wkly Rep.\u20082005;54:1052\u20131053"},{"key":"2021120902202448000_R16","unstructured":"Christopher KL, Saravolatz LD, Bush TL, Conway WA. The potential role of respiratory therapy equipment in cross infection: a study using a canine model for pneumonia. Am Rev Respir Dis.\u20081983;128:271\u2013275"}],"container-title":["Pediatrics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/publications.aap.org\/pediatrics\/article-pdf\/121\/1\/82\/1122136\/zpe00108000082.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/publications.aap.org\/pediatrics\/article-pdf\/121\/1\/82\/1122136\/zpe00108000082.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,5,15]],"date-time":"2023-05-15T14:40:16Z","timestamp":1684161616000},"score":1,"resource":{"primary":{"URL":"https:\/\/publications.aap.org\/pediatrics\/article\/121\/1\/82\/71042\/Heated-Humidified-High-Flow-Nasal-Cannula-Therapy"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2008,1,1]]},"references-count":16,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2008,1,1]]},"published-print":{"date-parts":[[2008,1,1]]}},"URL":"https:\/\/doi.org\/10.1542\/peds.2007-0957","relation":{},"ISSN":["0031-4005","1098-4275"],"issn-type":[{"value":"0031-4005","type":"print"},{"value":"1098-4275","type":"electronic"}],"subject":[],"published":{"date-parts":[[2008,1,1]]}}}