Variability in low-flow oxygen delivery by nasal cannula evaluated in neonatal and infant airway replicas

Background: The nasal cannula is considered a trusted and effective means of administering low-flow oxygen and is widely used for neonates and infants requiring oxygen therapy, despite an understanding that oxygen concentrations delivered to patients are variable. Methods: In the present study, realistic nasal airway replicas derived from medical scans of children less than 3 months old were used to measure the fraction of oxygen inhaled (FiO(2)) through nasal cannulas during low-flow oxygen delivery. Parameters influencing variability in FiO(2) were evaluated, as was the hypothesis that measured FiO(2) values could be predicted using a simple, flow-weighted calculation that assumes ideal mixing of oxygen with entrained room air. Tidal breathing through neonatal and infant nasal airway replicas was controlled using a lung simulator. Parameters for nasal cannula oxygen flow rate, nasal airway geometry, tidal volume, respiratory rate, inhalation/exhalation, or I:E ratio (t(i)/t(e)), breath waveform, and cannula prong insertion position were varied to determine their effect on measured FiO(2). In total, FiO(2) was measured for 384 different parameter combinations, with each combination repeated in triplicate. Analysis of variance (ANOVA) was used to assess the influence of parameters on measured FiO(2). Results: Measured FiO(2) was not appreciably affected by the breath waveform shape, the replica geometry, or the cannula position but was significantly influenced by the tidal volume, the inhalation time, and the nasal cannula flow rate. Conclusions: The flow-weighted calculation overpredicted FiO(2) for measured values above 60%, but an empirical correction to the calculation provided good agreement with measured FiO(2) across the full range of experimental data.