Clearance was assessed at NHF of 20–60 L/min with a symmetrical interface (SI) and an asymmetrical interface (AI). Clearance was investigated with volumetric capnography in an adult upper-airway model, which was ventilated by a lung simulator with entrained carbon dioxide (CO 2) at respiratory rates (RR) of 15–45 min −1 and at 18 min −1 with chronic obstructive pulmonary disease (COPD) breathing patterns. The hypothesis is that an increase in asymmetrical occlusion of the nares leads to an improvement in dead-space clearance resulting in a reduction in re-breathing. Pressure mainly depends on flow rate and nare occlusion. Positive airway pressure that dynamically changes with breathing, and clearance of anatomical dead space are the key mechanisms of noninvasive respiratory support with nasal high flow (NHF).
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