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 Table of Contents  
EBN SYNOPSIS - EVIDENCE-BASED NEONATOLOGY SYNOPSIS
Year : 2014  |  Volume : 3  |  Issue : 3  |  Page : 139-140

Heated humidified high-flow nasal cannulae: A good alternative to nasal continuous positive airway pressure


Department of Pediatrics, King Saud University, Riyadh, Saudi Arabia

Date of Web Publication8-Sep-2014

Correspondence Address:
Khalid AlFaleh
Department of Pediatrics, King Saud University, Riyadh
Saudi Arabia
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2249-4847.140390

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How to cite this article:
Ignacio L, AlFaleh K. Heated humidified high-flow nasal cannulae: A good alternative to nasal continuous positive airway pressure. J Clin Neonatol 2014;3:139-40

How to cite this URL:
Ignacio L, AlFaleh K. Heated humidified high-flow nasal cannulae: A good alternative to nasal continuous positive airway pressure. J Clin Neonatol [serial online] 2014 [cited 2021 Aug 2];3:139-40. Available from: https://www.jcnonweb.com/text.asp?2014/3/3/139/140390


  Commentary On Top


Collins CL, Holberton JR, Barfield C, Davis PG. A randomized controlled trial to compare heated humidified high-flow nasal cannulae with nasal continuous positive airway pressure postextubation in premature infants. J Pediatr 2013;162:949-541.

This article is a revised version of the originally published synopsis on the Journal of Clinical Neonatology 2nd issue, 2013. J Clin Neonatol. 2013 Apr-Jun; 2 (2):75-77


  Context Top


Nasal continuous positive airway pressure (NCPAP) has been utilized to support the respiratory efforts and prevent extubation failures in preterm infants for the last three decades. The use of NCPAP might results in septal trauma if not delivered under experienced hands.

Heated Humidified High-Flow Nasal Cannulae (HHHFNC) is better tolerated by the preterm and has its utilization has spread all over the world over the last 10 years.


  Methods Top


Study design

A single center randomized, controlled trial was carried out in Royal Women's Hospital, Melbourne, Victoria, Australia from January 1, 2009 to July 31, 2011.

Outcome

Extubation failure within the 7 days after extubation and was defined as follows:

  • Apnea (respiratory pause > 20 s), >6 episodes in 6 h or 1 requiring intermittent positive pressure ventilation
  • Acidosis, pH <7.25 and PCO 2 > 66 mmHg
  • And >15% sustained increase in a fraction of inspired oxygen (FiO 2) from extubation.


Population

Inclusion


Infants born at <32 weeks' gestation, required positive pressure ventilation and ready for extubation were enrolled.

Exclusion

  • Suspected upper-airway obstruction
  • Congenital airway malformations
  • Or major cardiopulmonary malformations.


Intervention

Heated Humidified High-Flow Nasal Cannulae via Vapotherm with 1.5-mm external diameter nasal cannulae (Vapotherm Inc., Stevensville, Maryland). Infants allocated to this group were extubated to a flow rate of 8 L/min. Flow rate was weaned to a minimum of 4 L/min gradually.

Nasal continuous positive airway pressure via Hudson binasal prongs, 3.7-4.6 mm external diameter (Hudson Respiratory Care Inc., Temecula, California). Infants randomized to NCPAP were extubated to a positive end-expiratory pressure (PEEP) of 8 cm H 2 O if the FiO 2 > 0.3 or a PEEP of 7 cm H 2 O if FiO 2 < 0.3. PEEP was weaned to a minimum of 5 cm H 2 O.

Randomization and allocation

Randomization was conducted through a random number generator and stratified by gestational age. Allocation concealment was assured via the use of opaque sealed envelops.


  Results Top


132 infants were enrolled. All infants were followed for the first 7 days after extubation, and 121 infants were followed until their discharge home.

The baseline demographics were similar except for enrolment of more male infants in the continuous positive airway pressure group.

Extubation failure rate and bronchopulmonary dysplasia were not statistically different in both groups. 20% of infants assigned to NCPAP were switched to HHHFNC in the first 7 days after extubation, as a result, of nasal trauma.


  Commentary Top


Evidence is accumulating addressing the efficacy of HHHFNC utilization in the management of preterm infants. Until date, most of the studies comparing NCPAP to HHHFNC were of small size and included larger preterm infants.

Evidence suggests the HHHFNC is comparable to NCPAP as a weaning method off conventional ventilation. The largest study to date was conducted in Australia and presented at the Pediatric Academic Society meeting, 2013 in Washington DC. The study included 300 preterm infants. HHHFNC was found to be noninferior to NCPAP for extubation failure in very low birth weight infants. The study failed to show noninferiority for infants <26 weeks. This new method of respiratory support in preterm infants was found to be more convenient to apply and results in less nasal trauma as compared to NCPAP.

We believe that evidence is still nonconclusive especially for the smallest preterm infants

lt; 26 weeks and that more data is needed. A head to head comparison of the two available devices with regard to efficacy is also needed.




 

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