A randomized pilot study comparing heated humidified high‐flow nasal cannulae with NIPPV for RDS

Kugelman, Amir; Riskin, Arieh; Said, Waseem; Shoris, Irit; Mor, Frida; Bader, David A.

doi:10.1002/ppul.23022

Cited by 79 publications

(110 citation statements)

References 30 publications

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“…There was no statistically significant difference in the rate of deaths in the group of preterm infants randomly assigned to receive HHHFNC compared with other NIV in the 5 studies revealing this outcome involving 922 infants (OR: 0.48 [0.18 to 1.24]; Fig 5). 21,24,27,38,40 Similarly, no statistically significant difference between the groups was found in the incidence of any pulmonary air leaks, as reported by 6 trials involving 992 preterm infants, 21,24,27,33,38,40 with an OR of 0.72 (0.28 to 1.83; Fig 6).…”

Section: Safety Of Hhhfncsupporting

confidence: 48%

“…All included studies compared HHHFNC with nCPAP, except 1 40 that compared infants on HHHFNC with those on NIPPV. All of the studies involved preterm infants who were ,37 weeks' gestation, but 2 studies only included infants born at ,32 weeks' gestation.…”

Section: Figurementioning

confidence: 99%

“…Because HHHFNC has been used both as a primary mode of respiratory support as well as after extubation from MV in preterm infants, we conducted separate analyses to compare failure rates. Four studies, involving 321 preterm infants, 38,40,44,45 compared efficacy of HHHFNC with other NIV when used as a primary mode of respiratory support. Pooled estimates of OR for failure of therapy for these studies was 1.02 (95% CI: 0.55 to 1.88; Fig 3A), and 1.12 (0.51 to 2.50) when the study comparing HHHFNC and NIPPV 40 was excluded.…”

Section: Efficacy Of Hhhfncmentioning

confidence: 99%

“…Four studies, involving 321 preterm infants, 38,40,44,45 compared efficacy of HHHFNC with other NIV when used as a primary mode of respiratory support. Pooled estimates of OR for failure of therapy for these studies was 1.02 (95% CI: 0.55 to 1.88; Fig 3A), and 1.12 (0.51 to 2.50) when the study comparing HHHFNC and NIPPV 40 was excluded. One of the trials in the primary use group had an uncertain risk of bias 44 ; excluding this from the analysis gave a pooled estimate of failure of 0.85 (0.43 to 1.69).…”

Section: Efficacy Of Hhhfncmentioning

confidence: 99%

“…33,38 Stratified data for preterm infants supported on HHHFNC as primary mode or after extubation were available from the authors for only 1 of the studies. 38 Thus, the final analysis included 6 studies where HHHFNC was compared with other forms of NIV as a primary mode of respiratory support 29,33,38,40,44,45 and 3 studies where these 2 modalities were compared after extubation from MV. 21,27,33 One study compared the 2 modes while weaning from respiratory support.…”

Section: Figurementioning

confidence: 99%

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Safety and Efficacy of High-Flow Nasal Cannula Therapy in Preterm Infants: A Meta-analysis

et al. 2015

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BACKGROUND AND OBJECTIVE: High-flow therapy is the most recent, and popular, mode of respiratory support in neonates. However, the evidence supporting its efficacy and safety has not yet been established. We conducted a systematic review and meta-analysis of clinical trials comparing efficacy and safety of high-flow therapy compared with other modes of noninvasive ventilation (NIV) in preterm infants.METHODS: Articles were indexed by using Medline, Embase, Scopus, OpenSIGLE, Health Management Information Consortium, and Cochrane Central Register of Controlled Trials. Randomized or quasirandomized clinical trials involving preterm infants, comparing high-flow therapy with other modes of NIV, and reporting extractable data on relevant outcomes, were selected. Data on efficacy, safety, and other common neonatal outcomes were extracted on predesigned forms. RESULTS:In this analysis, we included 1112 preterm infants, participating in 9 clinical trials. High-flow therapy was similar in efficacy to other modes of NIV in preterm infants when used as primary support (odds ratio of failure of therapy, 1.02 [95% confidence interval: 0.55 to 1.88]), as well as after extubation (1.09 [0.58 to 2.02]). There were no significant differences in odds of death (0.48 [0.18 to 1.24]) between the groups. Preterm infants supported on highflow had significantly lower odds of nasal trauma (0.13 [0.02 to 0.69]).CONCLUSIONS: High-flow therapy appears to be similar in efficacy and safety to other conventional modes of NIV in preterm infants. It is associated with significantly lower odds of nasal trauma. Caution needs to be exercised in extreme preterm infants because of the paucity of published data.

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Section: Safety Of Hhhfncsupporting

confidence: 48%

Section: Figurementioning

confidence: 99%

Section: Efficacy Of Hhhfncmentioning

confidence: 99%

Section: Efficacy Of Hhhfncmentioning

confidence: 99%

Section: Figurementioning

confidence: 99%

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Safety and Efficacy of High-Flow Nasal Cannula Therapy in Preterm Infants: A Meta-analysis

et al. 2015

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Heated, Humidified High-Flow Nasal Cannula vs Nasal Continuous Positive Airway Pressure for Respiratory Distress Syndrome of Prematurity

et al. 2016

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IMPORTANCE Heated, humidified high-flow nasal cannula (HHHFNC) has gained increasing popularity as respiratory support for newborn infants thanks to ease of use and improved patient comfort. However, its role as primary therapy for respiratory distress syndrome (RDS) of prematurity needs to be further elucidated by large, randomized clinical trials. OBJECTIVE To determine whether HHHFNC provides respiratory support noninferior to nasal continuous positive airway pressure (nCPAP) or bilevel nCPAP (BiPAP) as a primary approach to RDS in infants older than 28 weeks' gestational age (GA). DESIGN, SETTING, AND PARTICIPANTS An unblinded, monocentric, randomized clinical noninferiority trial at a tertiary neonatal intensive care unit. Inborn infants at 29 weeks 0 days to 36 weeks 6 days of GA were eligible if presenting with mild to moderate RDS requiring noninvasive respiratory support. Criteria for starting noninvasive respiratory support were a Silverman score of 5 or higher or a fraction of inspired oxygen higher than 0.3 for a target saturation of peripheral oxygen of 88% to 93%. Infants were ineligible if they had major congenital anomalies or severe RDS requiring early intubation. Infants were enrolled between

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Early nasal intermittent positive pressure ventilation (NIPPV) versus early nasal continuous positive airway pressure (NCPAP) for preterm infants

Lemyre

Laughon

Bose

et al. 2016

Cochrane Database of Systematic Reviews

121

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A randomized pilot study comparing heated humidified high‐flow nasal cannulae with NIPPV for RDS

Abstract: Our pilot study suggests that HHHFNC maybe as effective as NIPPV in preventing endotracheal ventilation in the primary treatment of RDS in premature infants (<35 weeks GA and BW >1,000 g).

Cited by 79 publications

References 30 publications

Safety and Efficacy of High-Flow Nasal Cannula Therapy in Preterm Infants: A Meta-analysis

Safety and Efficacy of High-Flow Nasal Cannula Therapy in Preterm Infants: A Meta-analysis

Heated, Humidified High-Flow Nasal Cannula vs Nasal Continuous Positive Airway Pressure for Respiratory Distress Syndrome of Prematurity

Early nasal intermittent positive pressure ventilation (NIPPV) versus early nasal continuous positive airway pressure (NCPAP) for preterm infants

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