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Review
. 2021 Jan 13:2021:6036891.
doi: 10.1155/2021/6036891. eCollection 2021.

How Much PEEP Does High Flow Deliver via Tracheostomy? A Literature Review and Benchtop Experiment

Martin Thomas  1   2 , Riddhi Joshi  3 , Grant Cave  4   5
Affiliations
Review

How Much PEEP Does High Flow Deliver via Tracheostomy? A Literature Review and Benchtop Experiment

Martin Thomas et al. Crit Care Res Pract. .

Abstract

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.

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Conflict of interest statement

The authors declare that there are no conflicts of interest regarding the publication of this paper. There are no financial or any other conflicts of interest with any of the authors to disclose.

Figures

Figure 1
Figure 1
PRISMA diagram to outline selection of cases for literature review.
Figure 2
Figure 2
(a) Image of benchtop experiment setup. (b) Airflow™ humidifier with Optiflow™ high flow circuit.
Figure 3
Figure 3
Box plots of pPEEP in cmH2O with 40 L/min, 50 L/min, and 60 L/min flows.
Figure 4
Figure 4
Mean and SE of pPEEP in cmH2O with 40 L/min, 50 L/min, and 60 L/min flows.
See this image and copyright information in PMC

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