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Continuous positive airway pressure and high flow nasal
cannula: the search for effectiveness continues
Hany Aly1 and Mohamed A. Mohamed2
Pediatric Research (2020) 87:11–12; https://doi.org/10.1038/s41390-019-0626-y

...Since nasal cannula is convenient to use by caregivers and
comfortable for infants when attached to their nose, a newer
version (RAM cannula, Neotech, Valencia, CA) that has a back hub
to attach to the ventilator has been designed with the hope to
deliver CPAP to the infant. However, this type of interface does not
allow laminar gas flow since both inspiratory and expiratory gas
meet in the common hub; turbulent gas flow typically creates high
resistance. Studies on the use of RAM cannula showed high airway
resistance and significant decrease in the delivered pressure.

Tidal volume transmission during non-synchronized nasal intermittent positive pressure ventilation via RAM® cannula

Journal of Perinatology volume 39pages723729(2019)

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And... Does the RAM Cannula Provide Continuous Positive Airway Pressure as Effectively as the Hudson Prongs in Preterm Neonates?

Neetu Singh et al

AM Journal Perinatol

Compared with the standard nasal interface for CPAP, the RAM cannula is made of softer material with a thin prong wall resulting in a larger caliber and less nasal trauma. However, there is increasing concern that the RAM cannula interface delivers suboptimal pressure compared with the standard nasal prongs, and the high expiratory resistance of the system increases expiratory workload and risk for hypercapnia

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