How Much PEEP Does High Flow Deliver via Tracheostomy? A Literature Review and Benchtop Experiment
Background. High flow tracheostomy (HFT) is a commonly used weaning and humidification strategy for tracheostomised patients, but little is known as to how much PEEP or mechanical benefit it offers. Patient anatomy and device characteristics differentiate it from high flow nasal cannula and the phys...
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Wiley
2021-01-01
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| Series: | Critical Care Research and Practice |
| Online Access: | http://dx.doi.org/10.1155/2021/6036891 |
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| author | Martin Thomas Riddhi Joshi Grant Cave |
| author_facet | Martin Thomas Riddhi Joshi Grant Cave |
| author_sort | Martin Thomas |
| collection | DOAJ |
| description | Background. High flow tracheostomy (HFT) is a commonly used weaning and humidification strategy for tracheostomised patients, but little is known as to how much PEEP or mechanical benefit it offers. Patient anatomy and device characteristics differentiate it from high flow nasal cannula and the physiological effects observed. Objectives. (1) To review the available literature on the effects of HFT on airway pressure and indices of gas exchange. (2) To quantify PEEP generated by a HFT circuit. Methods. A randomised benchtop experiment was conducted, with a size 8 uncuffed Portex tracheostomy connected to an Optiflow™ with Airvo 2™ humidifier system. The tracheostomy tube was partially immersed in water to give rise to a column of water within the inner surface of the tube. An air fluid interface was generated with flows of 40 L/min, 50 L/min, and 60 L/min. The amount of potential PEEP (pPEEP) generated was determined by the distance the water column was pushed downward by the flow delivered. Findings. Overall 40 L/min, 50 L/min, and 60 L/min provided pPEEP of approximately 0.3 cmH2O, 0.5 cmH2O, and 0.9 cmH2O, respectively. There was a statistically significant change in pPEEP with change in flows from 40–60 L/min with an average change in pPEEP of 0.25–0.35 cmH2O per 10 L/min flow (p value <0.01). Interpretation. HFT can generate measurable and variable PEEP despite the open system used. The pPEEP generated with HFT is minimal despite statistically significant change with increasing flows. This pPEEP is unlikely to provide mechanical benefit in weaning patients off ventilatory support. |
| format | Article |
| id | doaj-art-a66a6338b06442468bcd3bb082cff00f |
| institution | Kabale University |
| issn | 2090-1305 2090-1313 |
| language | English |
| publishDate | 2021-01-01 |
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| series | Critical Care Research and Practice |
| spelling | doaj-art-a66a6338b06442468bcd3bb082cff00f2025-02-03T01:20:48ZengWileyCritical Care Research and Practice2090-13052090-13132021-01-01202110.1155/2021/60368916036891How Much PEEP Does High Flow Deliver via Tracheostomy? A Literature Review and Benchtop ExperimentMartin Thomas0Riddhi Joshi1Grant Cave2Department of Cardiology, Dubbo Base Hospital, Dubbo, NSW 2830, AustraliaDepartment of Anaesthesia, Dubbo Base Hospital, Dubbo, NSW 2830, AustraliaDubbo Base Hospital, Dubbo, NSW 2830, AustraliaBackground. High flow tracheostomy (HFT) is a commonly used weaning and humidification strategy for tracheostomised patients, but little is known as to how much PEEP or mechanical benefit it offers. Patient anatomy and device characteristics differentiate it from high flow nasal cannula and the physiological effects observed. Objectives. (1) To review the available literature on the effects of HFT on airway pressure and indices of gas exchange. (2) To quantify PEEP generated by a HFT circuit. Methods. A randomised benchtop experiment was conducted, with a size 8 uncuffed Portex tracheostomy connected to an Optiflow™ with Airvo 2™ humidifier system. The tracheostomy tube was partially immersed in water to give rise to a column of water within the inner surface of the tube. An air fluid interface was generated with flows of 40 L/min, 50 L/min, and 60 L/min. The amount of potential PEEP (pPEEP) generated was determined by the distance the water column was pushed downward by the flow delivered. Findings. Overall 40 L/min, 50 L/min, and 60 L/min provided pPEEP of approximately 0.3 cmH2O, 0.5 cmH2O, and 0.9 cmH2O, respectively. There was a statistically significant change in pPEEP with change in flows from 40–60 L/min with an average change in pPEEP of 0.25–0.35 cmH2O per 10 L/min flow (p value <0.01). Interpretation. HFT can generate measurable and variable PEEP despite the open system used. The pPEEP generated with HFT is minimal despite statistically significant change with increasing flows. This pPEEP is unlikely to provide mechanical benefit in weaning patients off ventilatory support.http://dx.doi.org/10.1155/2021/6036891 |
| spellingShingle | Martin Thomas Riddhi Joshi Grant Cave How Much PEEP Does High Flow Deliver via Tracheostomy? A Literature Review and Benchtop Experiment Critical Care Research and Practice |
| title | How Much PEEP Does High Flow Deliver via Tracheostomy? A Literature Review and Benchtop Experiment |
| title_full | How Much PEEP Does High Flow Deliver via Tracheostomy? A Literature Review and Benchtop Experiment |
| title_fullStr | How Much PEEP Does High Flow Deliver via Tracheostomy? A Literature Review and Benchtop Experiment |
| title_full_unstemmed | How Much PEEP Does High Flow Deliver via Tracheostomy? A Literature Review and Benchtop Experiment |
| title_short | How Much PEEP Does High Flow Deliver via Tracheostomy? A Literature Review and Benchtop Experiment |
| title_sort | how much peep does high flow deliver via tracheostomy a literature review and benchtop experiment |
| url | http://dx.doi.org/10.1155/2021/6036891 |
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