Cannula With Long and Narrow Tubing vs Short Binasal Prongs for Noninvasive Ventilation in Preterm Infants

Abstract

with long and narrow tubing (CLNT) has gained increasing popularity for applying noninvasive respiratory support for newborn infants thanks to ease of use, perceived patient comfort, and reduced nasal trauma. However, there is concern that this interface delivers reduced and suboptimal support. OBJECTIVE To determine whether CLNT is noninferior to short binasal prongs and masks (SPM) when providing nasal intermittent positive pressure ventilation (NIPPV) in preterm infants.DESIGN, SETTING, AND PARTICIPANTS This randomized controlled, unblinded, prospective noninferiority trial was conducted between December 2017 and December 2019 at 2 tertiary neonatal intensive care units. Preterm infants born between 24 weeks' and 33 weeks and 6 days' gestation were eligible if presented with respiratory distress syndrome with the need for noninvasive ventilatory support either as initial treatment after birth or after first extubation. Analysis was performed by intention to treat.INTERVENTIONS Randomization to NIPPV with either CLNT or SPM interface. MAIN OUTCOMES AND MEASURESThe primary outcome was the need for intubation within 72 hours after NIPPV treatment began. Noninferiority margin was defined as 15% or less absolute difference. RESULTSOverall, 166 infants were included in this analysis, and infant characteristics and clinical condition (including fraction of inspired oxygen, PCO 2 , and pH level) were comparable at recruitment in the CLNT group (n = 83) and SPM group (n = 83). The mean (SD) gestational age was 29.3 (2.2) weeks vs 29.2 (2.5) weeks, and the mean (SD) birth weight was 1237 (414) g vs 1254 (448) g in the CLNT and SPM groups, respectively. Intubation within 72 hours occurred in 12 of 83 infants (14%) in the CLNT group and in 15 of 83 infants (18%) in the SPM group (risk difference, −3.6%; 95% CI, −14.8 to 7.6 [within the noninferiority margin], χ 2 P = .53). Moderate to severe nasal trauma was significantly less common in the CLNT group compared with the SPM group (4 [5%] vs 14 [17%]; P = .01). There were no differences in other adverse events or in the course during hospitalization.CONCLUSIONS AND RELEVANCE In this study, CLNT was noninferior to SPM in providing NIPPV for preterm infants, while causing significantly less nasal trauma.

Nasal Cannula with Long and Narrow Tubing for Non-Invasive Respiratory Support in Preterm Neonates: A Systematic Review and Meta-Analysis

“…Of the 105 studies identified during the systematic search of the literature, a total of six studies were included (RCTs: 3 studies (Maram 2021, Hochwald 2021, and Gokce 2021) ( n = 521); [ 24 , 25 , 26 ] observational studies: 3 studies (Singh 2018, Sharma 2020, Drescher 2018) ( n = 138)) [ 21 , 23 ]. The PRISMA flow is depicted in Figure 1 .…”

“…The PRISMA flow is depicted in Figure 1 . The three RCTs had enrolled neonates born at a gestational age of 28–34 weeks [ 24 , 25 , 26 ]. Two of the RCTs (Gokce 2021 and Hochwald 2021) [ 24 , 25 ] used NIPPV as the NRS modality, and one (Maram 2021) used CPAP [ 26 ].…”

“…There is a lot of ambiguity in the published literature with respect to pressure transmission with CLNT [ 19 , 21 ]. Similarly, results from clinical studies on CLNT in preterm neonates show conflicting data on various outcomes such as treatment failure and need for invasive mechanical ventilation (IMV) [ 21 , 22 , 23 , 24 , 25 , 26 ]. It is therefore essential that the literature related to CLNT is systematically evaluated to derive meaningful conclusions about its use in clinical practice.…”

Topic Sessions

“…However, there is concern that this interface delivers reduced and suboptimal support. In a noninferiority randomized clinical trial 6 that included 166 preterm infants at 24 weeks’ to 33 weeks and 6 days’ gestation requiring NIPPV, intubation within 72 hours occurred in 14% in the group using RAM cannula and in 18% in the short binasal prongs and masks group (95% CI within the noninferiority margin). Moderate to severe nasal trauma was significantly less common in the group using cannulas with long and narrow tubing.…”

RAM cannula with Cannulaide versus Hudson prongs for delivery of nasal continuous positive airway pressure in preterm infants: an RCT

“…While Hochwald et al made a similar comparison for preterm neonates receiving NIPPV 12 , there are no adequately powered studies that compared these two interfaces in reducing nasal injuries. As previous physiological and in vivo studies 13 – 17 demonstrated concerns on the efficacy of RAM cannula to deliver the set pressures, we used Cannulaide, a hydrocolloid protective barrier which secures cannula in place and provides a seal, in RAM cannula group for snugly fitting the nasal cannula, preventing leak and allowing better delivery of CPAP pressures.…”