Review Article

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

Table 1

Description of studies included in review.

Author (year)Study typeNo. of patients/subjectsHigh flows administeredVariables measuredResultsStatistically significant variables

Corley et al. (2017)Randomised crossover study (HFT vs TPiece)2050 L/minEELV, TV, paw (mean), SpO2/FiO2, EtCO2, RR, HR, dyspnoea scoreMean airway pressures 0.7 cmH2O; mean difference between HFT and T PieceSpO2/FiO2, Mean Airway Pressure

Natalini et al. (2019)Single centre randomised crossover study (HFT vs standard oxygen)2610 L/min, 30 L/min, 50 L/minABG/ RR / peak and mean expiratory pressurePeak expiratory pressures 1.8 cmH2O (1.4–2.2 cmH2O) with 50 L/min vs. 1.3 cmH2O (0.9–2 cmH2O) with standard oxygen, p=0.001
Mean expiratory pressure 1.2 cmH2O (1–1.5 cmH2O) with 50 L/min vs. 0.8 cmH2O (0.5–1.3 cmH2O) with standard oxygen, p<0.001
PaO2/FiO2, RR, peak and mean expiratory pressures

Stripoli et al. (2019)Single centre unblinded crossover study (HF1/oxygen/HF2)1450 L/minABG/RR/EAdi/Pmusc/ work of breathingNo airway pressure was monitoredNone

Chen et al. (2019)Animal randomised crossover study/bench experiment (TPiece/HFT/modified HFT)640 L/min for animal study, 10 L/min–60 L/min for bench studyABG/RR/paw/PEEP/PTP/resistanceAnimal study bench experiment
1± 0.3 cmH2O (mean paw) 40 L/min
1.2 ± 0.3 cmH2O (mean paw) 50 L/min
1.5 ± 0.3 cmH2O (mean paw) 60L /min
Paw, resistance, EELV, PaO2/FiO2

Moorhouse et al. (2015)Benchtop experiment468 Recordings5 L/min to 30 L/min in increments of 5 L/minAirway pressure and resistance to flow0.15 cmH2O for 10 L/min (paw)
0.47 cmH2O for 20 L/min (paw)
0.94 cmH2O for 30 L/min (paw)
Resistance and pressure

Mitaka et al. (2018)Case report240 L/minAirway pressureCase 2
0.21–0.3 cmH2O for 10 L/min (paw)
0.21–0.56 cmH2O for 20 L/min (paw)
0.54–0.91 cmH2O for 30 L/min (paw)
0.76–2.01 cmH2O for 40 L/min (paw)
1.17–2.01 cmH2O for 50 L/min (paw)
1.76–2.01 cmH2O for 60 L/min (paw)
NA

Abbreviations: EELV: end expiratory lung volume; TV: tidal volume; Paw: airway pressure; SpO2: oxygen saturation; FiO2: fraction of inspired oxygen; EtCO2: end tidal CO2; RR: respiratory rate; HR: heart rate; HFT: high flow tracheostomy; cmH2O: centimetres of water; ABG: arterial blood gas; Pmusc: pressure generated by inspiratory muscles; EAdi: electrical activity of the diaphragm; PTP: pressure time product; PEEP: positive end expiratory pressure; PaO2: partial pressure of oxygen.