The Use of Bi-Nasal Prongs for Delivery of Non-Invasive Ventilation to Foals

Simple Summary Non-invasive ventilation (NIV) is a method of providing respiratory support without the need for airway intubation. In human patients, NIV can be delivered through a helmet, a mask or nasal prongs. The current study was undertaken to assess whether foals tolerate nasal prongs for the delivery of NIV. Bi-nasal prongs were well tolerated by healthy, standing foals, remaining in place for the allocated five minutes in four of six unsedated foals and, subsequently, in five of six lightly sedated foals. All foals tolerated NIV through bi-nasal prongs, although increasing airway pressures were associated with increased air leakage and discomfort in most foals, prompting discontinuation of treatment. These results suggest that bi-nasal prongs might be suitable for NIV in foals but that design or fitting requires further optimization and, in clinical cases, the lowest possible pressures should be used commensurate with necessary respiratory support.Abstract Non-invasive ventilation (NIV) is a method of providing respiratory support without the need for airway intubation. The current study was undertaken to assess tolerance to bi-nasal prongs and NIV in healthy, standing, lightly sedated foals. Bi-nasal prongs were well tolerated by foals, remaining in place for the allocated five minutes in four of six unsedated foals and, subsequently, in five of six lightly sedated foals. All foals tolerated NIV through bi-nasal prongs, although increasing airway pressures were associated with increases in inspiratory volume, duration of inspiration and air leakage in most foals. These changes preceded discontinuation/intolerance of NIV on the basis of behaviour changes consistent with discomfort. Increased circuit leakage was associated with reduced return of expired air to the ventilator and increasing disparity between inspiratory and expiratory times and tidal volumes. The study results suggest that bi-nasal prongs might be suitable for NIV but that design or fitting requires further optimization and that behaviour and ventilator variables should be monitored to assess patient tolerance of the procedure.