Medicina pulmonar y respiratoria

Computational Fluid Dynamics Modeling of Extrathoracic Airway Flush: Evaluation of High Flow Nasal Cannula Design Elements

Abstract

Thomas L Miller, Babak Saberi and Shadi Saberi

Objective: High flow nasal cannula (HFNC) is an evolving respiratory therapy whereby high flow rates of conditioned breathing gas are delivered into the nasal cavity to purge anatomical dead space of CO2 rich expired gas. The aim of this project was to create a computational fluid dynamics (CFD) model to evaluate the fluid patterns in the human nasal and pharyngeal cavities with HFNC application, and quantify time to purge for two cannula configurations. Methods: Three-dimensional geometry of the human airway was used to define the extrathoracic dead space and the two cannula designs tested incorporate large vs small bore nasal prong configurations (Vapotherm, Exeter, NH, USA). The fluid flow simulations were performed using FLOW-3D software, set up for a cannula flow rate of 20 L·min-1 and run until steady state. Results: Basic flow patterns were similar between cannulae, creating vortices around a central inward flow path. Flow velocity around the vortices was greater with the small prong cannula, resulting in a lower pressure in each region of the nasal and nasopharyngeal space. The calculation of purge time revealed that the small prong nasal cannula was able to clear the nasal, pharyngeal and oral cavities in 2.2 seconds, whereas the large bore cannula required 3.6 seconds (64% longer). Conclusion: The current CFD data validate that a smaller bore nasal prong facilitates the purge action, which is related to velocity and dynamic energy induced by the tighter prong nozzle as opposed to the lesser occlusion of the nares.