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The standard high-flow tracheal (HFT) interface was modified by adding a 5-cm H 2 O/L/s resistor to the expiratory port. First, in a test lung simulating spontaneous breathing, we found that the modified HFT caused an elevation in airway pressure as a power function of flow. Then, three tracheal oxygen treatments (T-piece oxygen at 10 L/min, HFT and modified HFT at 40 L/min) were delivered in a random crossover fashion to six tracheostomized pigs before and after the induction of lung injury. The modified HFT induced a significantly higher airway pressure compared with that in either T-piece or HFT ( p  < 0.001). Expiratory resistance significantly increased during modified HFT ( p  < 0.05) to a mean value of 4.9 to 6.7 cm H 2 O/L/s. The modified HFT induced significant augmentation in end-expiratory lung volume ( p  < 0.05) and improved oxygenation for lung injury model ( p  = 0.038) compared with the HFT and T-piece. There was no significant difference in esophageal pressure swings, transpulmonary driving pressure or pressure time product among the three treatments ( p  > 0.05). In conclusion, the modified HFT with additional expiratory resistance generated a clinically relevant elevation in airway pressure and lung volume. Although expiratory resistance increased, inspiratory effort, lung stress and work of breathing remained within an acceptable range.

Additional Expiratory Resistance Elevates Airway Pressure and Lung Volume during High-Flow Tracheal Oxygen via Tracheostomy