Session: Neonatal Pulmonology - Clinical Science 6: PEEP and Non-Invasive Ventilation
702 - An Observational Pilot Crossover Study Evaluating and Comparing EDI Metrics in Continuous Positive Airway Pressure and High Velocity Nasal Cannula
Monday, April 27, 2026
8:00am - 10:00am ET
Publication Number: 4686.702
Natalia Mavrogiannis, Hassenfeld Children's Hospital at NYU Langone, Jersey City, NJ, United States; Pradeep Mally, New York University Grossman School of Medicine, New York, NY, United States; Sarah Fleishaker, Hassenfeld Children's Hospital at NYU Langone, New York, NY, United States
Director, Neonatology New York University Grossman School of Medicine New York, New York, United States
Background: Non-invasive respiratory support is a standard practice in neonatal intensive care unit (NICU) for a variety of respiratory diseases. Two widely used modalities are continuous positive airway pressure (CPAP) and high velocity nasal cannula (HVNC). There is little evidence to guide if one device should be used over another and there are limited studies comparing the two. Objective: The objective of this study was to use electrical activity of the diaphragm (Edi) to compare the respiratory mechanics and PEEP delivery between these two devices. Our hypothesis was that CPAP would deliver a more consistent PEEP than HVNC. Design/Methods: This was a prospective, observational crossover study of infants > 32 weeks gestational age (GA) at < 7 days of life requiring CPAP +5 mmH2O or HVNC 6L/min. Maternal and infant demographics and clinical data were collected. Edi catheter was used to measure lung mechanics of CPAP versus HVNC for a total of 8 hours, with infants on each modality for 4 hours. Results: 12 infants with a mean gestational age of 34.5 weeks (range 32-40 weeks) were enrolled. The average Edi peak on CPAP and HVNC were 12.6 + 6mcV and 12.3 + 4.4 (p = 0.89). The average Edi min values were 2.81 + 1.9 and 2.99 + 1.3 on CPAP and HVNC (p=0.80) respectively.
Conclusion(s): Our study shows that when comparing CPAP to HVNC using Edi metrics in infants with respiratory distress, the Edi peak and Edi min values were comparable. This indicates that, at equivalent support levels, PEEP was similarly maintained on HVNC and CPAP. We show that HVNC is safe to use in infants >32 weeks because of sustained deliverable PEEP. More studies need to be done in infants of lower GA to demonstrate similar consistent deliverable PEEP with HVNC.
