Changes in lung volume and work of breathing: A comparison of two variable-flow nasal continuous positive airway pressure devices in very low birth weight infants

Variable flow nasal continuous positive airway pressure (VF-NCPAP) recruits lung volume more effectively and reduces work of breathing (WOB) compared to constant-flow NCPAP (CF-NCPAP) in very low birth weight (VLBW) infants. Because different VF-NCPAP devices have somewhat different flow patterns, whether different VF-NCPAP devices function similarly is unknown. We compared two VF-NCPAP devices: the Infant Flow™ (EME, Ltd.) and the Arabella® (Hamilton Medical) to assess whether lung volume recruitment and WOB were similar in VLBW infants requiring NCPAP. Eighteen infants < 1,500 g were studied on both NCPAP devices applied in random order. All infants required NCPAP for mild respiratory distress. Calibrated DC-coupled respiratory inductance plethysmography (RIP) was used to assess lung volume changes. NCPAP was first increased to 8 cmH₂O to allow comparable recruitment in all infants, and then was slowly decreased to 6, 4, and 0 cmH₂O, with data collection at each level. Mean birth weight (±SD) was 1,107 ± 218 g, gestational age was 27.9 ± 2.0 weeks, weight at study was 1,092 ± 222 g, and age at study was 4.6 ± 4.3 days. There were no differences in lung volume recruitment overall or at any NCPAP level (P = 0.943). No differences were found in either inspiratory WOB (P = 0.468) or in resistive WOB (P = 0.610) between devices. Compliance, tidal volume, respiratory rate, and minute ventilation were also similar. Despite differences in flow characteristics between the two VF-NCPAP devices we studied, lung volume recruitment and WOB were similar.