Performance Evaluation of Nasal Prong Interface for CPAP Delivery on a Critical Care Ventilator: A Bench Experiment

BACKGROUND: The RAM cannula (Neotech, Valencia, CA) has become a commonly used interface for CPAP in neonatal intensive care. Performance characteristics of this interface used with a critical care ventilator are not well described. METHODS: This was a bench study utilizing a lung simulator configured as an actively breathing infant (weights of 800 g, 1.5 kg, and 3 kg) with moderate lung disease and a critical care ventilator in CPAP mode with leak compensation on. Three sizes of the RAM cannulae (preemie, newborn, and infant) were compared to 3 BabyFlow nasal prongs (Drager Medical, Lubeck, Germany) (medium, large, and extra-large). Fabricated nasal models produced a 70% occlusive fit for the RAM cannula and an occlusive fit with the Drager prongs. Delivered flow and pressure levels were recorded at 9 CPAP levels between 5 and 20 cm H2O. RESULTS: The Drager prongs produced a mean airway pressure ((P) over bar (aw)) within 0.20 cm H2O (range -0.10 to 0.35) of the set CPAP across all evaluated prong sizes and CPAP levels. In contrast, the RAM cannula produced (P) over bar (aw) values that averaged 8.5 cm H2O (range -15 to -3.5) below the set CPAP levels. The deficit in delivered versus target CPAP level for the RAM cannula increased with greater set CPAP. Set CPAP of 5 cm H2O delivered (P) over bar (aw) values that ranged from 0.6 to 1.5 cm H2O (difference of 3.5-4.4 cm H2O). Set CPAP of 20 cm H2O delivered (P) over bar (aw) values that ranged from 5.0 to 8.4 cm H2O (difference of 11.7-15 cm H2O). Inspiratory flow required to achieve set CPAP levels did not differ between interfaces, suggesting high resistance in the RAM cannula device masks the delivered CPAP levels. CONCLUSIONS: Use of the RAM cannula with a 30% leak on a critical care ventilator delivered (P) over bar (aw) values lower than set CPAP. This may be clinically meaningful and should be considered when choosing a nasal interface.

Automated summary

The study compared the performance of RAM cannula and BabyFlow nasal prongs under different CPAP levels using a lung simulator. Results showed that the RAM cannula delivered lower CPAP values than set levels, highlighting the importance of considering this factor when choosing a nasal interface.