Effects of high-flow nasal cannula on end-expiratory lung impedance in semi-seated healthy subjects

Abstract

BACKGROUND: High-flow nasal cannula (HFNC) enables delivery of humidified gas at high flow while controlling the FIO2. Although its use is growing in patients with acute respiratory failure, little is known about the impact of HFNC on lung volume. Therefore, we aimed to assess lung volume changes in healthy subjects at different flows and positions. METHODS: This was a prospective physiological study performed in 16 healthy subjects. The changes in lung volumes were assessed by measuring end-expiratory lung impedance by using electrical impedance tomography. All the subjects successively breathed during 5 min in these following conditions: while in a supine position without HFNC (T0) and 3 measurements in a semi-seated position at 45° without HFNC (T1), and with HFNC at a flow of 30 L/min (T2), and 50 L/min (T3). RESULTS: Compared with the supine position, the values of end-expiratory lung impedance significantly increased with the subjects in a semi-seated position. End-expiratory lung impedance significantly increased after HFNC initiation in subjects in a semi-seated position and further increased by increasing flow at 50 L/min. When taking the end-expiratory lung impedance measurement in subjects in a semi-seated position (T1) as reference, the differences among the medians of global end-expiratory lung impedance were statistically significant (P < .001), which amounted to 1.05 units in T1; 1.12 units in T2; and 1.44 units in T3 (P < .05 for all comparisons, Wilcoxon test). The breathing frequency did not differ between the supine and semi-seated position (T0 and T1) but significantly decreased after initiation of HFNC and further decreased at high flow. T0 and T1 were not different (P = .13); whereas there was a statistically significant difference among T1, T2, and T3 (P < .05, post hoc test with Bonferroni correction). CONCLUSIONS: In healthy subjects, the semi-seated position and the use of HFNC increased end-expiratory lung impedance globally. These changes were accompanied by a significant decrease in the breathing frequency. Key words: high-flow nasal cannula; oxygen inhalation therapy; high-flow devices; electrical impedance tomography; end-expiratory lung impedance; end-expiratory lung volume. [Respir Care 2018;63(8):1016 –1023. © 2018 Daedalus Enterprises].