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Assessment of resistance of nasal continuous positive airway pressure interfaces
  1. Elys Alexandra Green1,
  2. Jennifer Anne Dawson2,3,4,
  3. Peter G Davis3,4,
  4. Antonio G De Paoli5,
  5. Calum Timothy Roberts1,2,6
  1. 1 Monash Newborn, Monash Medical Centre, Clayton, Victoria, Australia
  2. 2 Newborn Research and Neonatal Services, The Royal Women’s Hospital, Parkville, Victoria, Australia
  3. 3 Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, Victoria, Australia
  4. 4 Murdoch Children’s Research Institute, Melbourne, Victoria, Australia
  5. 5 Department of Paediatrics, Royal Hobart Hospital, Hobart, Tasmania, Australia
  6. 6 Department of Paediatrics, Monash University, Melbourne, Victoria, Australia
  1. Correspondence to Dr Elys Alexandra Green, Monash Newborn, Monash Children’s Hospital, Clayton, VIC 3168, Australia;{at}


Objective To compare the resistance of interfaces used for the delivery of nasal continuous positive airway pressure (CPAP) in neonates, as measured by the generated system pressure at fixed gas flows, in an in vitro setting.

Design Gas flows of 6, 8 and 10 L/min were passed through three sizes of each of a selection of available neonatal nasal CPAP interfaces (Hudson prong, RAM Cannula, Fisher & Paykel prong, Infant Flow prong, Fisher & Paykel mask, Infant Flow mask). The expiratory limb was occluded and pressure differential measured using a calibrated pressure transducer.

Results Variation in resistance, assessed by mean pressure differential, was seen between CPAP interfaces. Binasal prong interfaces typically had greater resistance at the smallest assessed sizes, and with higher gas flows. However, Infant Flow prongs produced low pressures (<1.5 cmH2O) at all sizes and gas flows. RAM Cannula had a high resistance, producing a pressure >4.5 cmH2O at all sizes and gas flows. Both nasal mask interfaces had low resistance at all assessed sizes and gas flows, with recorded pressure <1 cmH2O in all cases.

Conclusions There is considerable variation in measured resistance of available CPAP interfaces at gas flows commonly applied in clinical neonatal care. Use of interfaces with high resistance may result in a greater drop in delivered airway pressure in comparison to set circuit pressure, which may have implications for clinical efficacy. Device manufacturers and clinicians should consider CPAP interface resistance prior to introduction into routine clinical care.

  • neonatology
  • respiratory
  • intensive care

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  • Contributors EAG performed the data collection and analysis, and was involved in the conception and design of the study and in interpretation of the findings. She also wrote the first draft of the manuscript. JAD, PGD, AGDP and CTR were involved in the conception and design of the study, interpretation of the findings and revision of the manuscript. All authors approved the final version of the manuscript for submission.

  • Funding CTR is supported by the Monash University Kathleen Tinsley Research Fellowship.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Patient consent for publication Not required.

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