Introduction
In contemporary clinical practice, 50–84% of patients are exposed to excess oxygen and hyperxemia as a result of efforts to prevent or reverse hypoxemia via various interfaces such as a nasal cannula, nasal catheter, venturi mask and non-rebreathing mask.1-4Recently, a systematic review and meta-analysis provides high-quality evidence that hyperoxia is life-threatening in acutely ill adults with acute myocardial infarction, sepsis, critical illness, stroke, trauma, cardiac arrest.5
Oxygen treatment can be divided into high-flow and low-flow systems. The high-flow system provides a flow that is equal to or exceeds the patient’s peak inspiratory flow and ensures a fixed FIO2, while the low-flow system is variable due to the entrained indoor air that dilutes the oxygen, resulting in a low FIO2.1,2,4 The precise FIO2 amount delivered is difficult to determine in spontaneously breathing patients because it is influenced by the breathing pattern, including the patient’s minute ventilation, f, VT, inspiratory time (TI), expiratory time (TE), functional apparatus dead space, inspiratory flow rate, expiratory flow rate and impact of open or closed mouth,1,2,4,6-9 particularly in patients with respiratory failure, which manifests as hypoventilation or hyperventilation.
Although oxygen therapy can reduce the symptoms of hypoxemia,10 but high concentrations of oxygen cause adverse effects such as chronic obstructive pulmonary disease(COPD)11 and type II respiratory failure.12 Clearly, more precise control  of the inspired oxygen concentration is very important for patients have a high respiratory rate (f) with shallow or deep breathing in lower lung compliance such as acute respiratory distress syndrome,13 left ventricular failure14 and pulmonary fibrosis15and increased airway resistance such as COPD16-18 and asthma.19,20 The nasal cannula provides oxygen flow at a rate of 1–5L/min,3 is the most widely used low-flow oxygen device for adults, children and infants.1-4Modern guidelines and the literature lack much data regarding the correlation between how much to give and breathing patterns in respiratory failure during low-flow oxygen therapy with a nasal cannula.1,2,6,21-26
We conducted this bench study to investigate the performance of nasal cannula in a manikin head-test lung-ventilator system to simulate a spontaneous breathing pattern in normal, restrictive and obstructive lung models. To describe the effects of various VT and f on the measured FIO2 near the carina and provide equations to estimate FIO2 during standard nasal cannula oxygen therapy.