Heated Humidified High-Flow Nasal Cannula for Prevention of Extubation Failure in Preterm Infants

Soonsawad, Sasivimon; Swatesutipun, Buranee; Limrungsikul, Anchalee; Nuntnarumit, Pracha

doi:10.1007/s12098-016-2280-2

Cited by 29 publications

(53 citation statements)

References 24 publications

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“…In contrast to studies of HFNC as postextubation support , Roberts et al found HFNC as primary support to be not only inferior to nCPAP, but the difference was obvious prior to full recruitment, and was significant in both the intention‐to‐treat and per‐protocol analyses. The authors posit the higher rate of treatment failure in the HFNC group ‘may reflect its reduced effectiveness in infants with surfactant‐deficient lungs’.…”

mentioning

confidence: 80%

Is high-flow nasal cannula noninferior to nasal CPAP for the initial management of preterm infants?

Kirkley

Hwang

2017

Acta Paediatr

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mentioning

confidence: 80%

Is high-flow nasal cannula noninferior to nasal CPAP for the initial management of preterm infants?

Kirkley

Hwang

2017

Acta Paediatr

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“…randomised 161 preterm infants <32 weeks' GA and found no difference in these outcomes overall, but treatment failure was higher with nHF in the smaller infants (26–28 +6 weeks' GA). A second, smaller study found a higher rate of treatment failure but a similar rate of intubation in infants <32 weeks' GA managed with nHF; the intubation rates were similar due to the use of rescue CPAP in the nHF arm.…”

Section: Indications For Nhf Therapymentioning

confidence: 91%

Nasal high flow therapy for neonates: Current evidence and future directions

Hodgson

Davis

Owen

2019

J Paediatrics Child Health

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Nasal high flow (nHF) therapy is a commonly used method of providing non‐invasive respiratory support for neonates. It has several potential mechanisms of action: continuous distending pressure, nasopharyngeal dead space washout, provision of heated and humidified gases and reduction of work of breathing. nHF is used in a number of clinical scenarios for preterm and term infants, including primary respiratory and post‐extubation support. In recent years, large trials have generated evidence pertinent to these indications. Novel applications for nHF in neonates warrant further research: during endotracheal intubation, for initial delivery room stabilisation of preterm infants and in conjunction with minimally invasive surfactant therapy.

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“…In the past, endotracheal intubation was the main respiratory support in preterm infants, but prolonged intubation can increase risks of infection, lung injury, and chronic lung disease. Therefore, the strategy has been shifted to initiate non-invasive respiratory support as soon as possible to minimize duration of mechanical ventilator [7].…”

Section: Pretermmentioning

confidence: 99%

The Effectiveness of the Heated Humidified High Flow Nasal Cannula as a Noninvasive Respiratory Support for Preterm Infants for Prevention of Extubation Failure

Nofal

Sheikh

Mahdy

et al. 2020

JAMMR

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Aims: To compare the efficacy and safety of the HHHFNC as a post extubation respiratory support of preterm infants who were initially required endotracheal intubation and conventional mechanical ventilator after birth at different flow rates (3 L/min and 6 L/min). Study Design: A Randomized controlled trial. Place and Duration of Study: Neonatal Intensive Care Unit, Pediatrics department, Tanta University Hospitals, over one-year period, from December 2018 to December 2019. Methodology: 30 preterm, with gestational age (30-36) weeks and birth weight ≥ 1300 g, were randomized to receive HHHFNC at either flow rate 3 or 6 L\min to prevent postextubation failure. Primary outcomes: the incidence of treatment failure of the HHHFNC at flow 3 and 6 L/min, which will require n CPAP or NIMV, or will require reintubation after successful extubation within 72 h. Secondary outcomes: rate of deaths within 72 hours post extubation, the total duration of all types of oxygen support, total duration of hospitalization and incidence of neonatal morbidities such as nasal trauma, BPD, symptomatic PDA, IVH ≥ grade II, pneumothorax, pulmonary hemorrhage, ROP, apnea, sepsis and NEC ≥ stage II. Results: The incidence of need for higher flow rate of HHHFNC (n =17, 56.6%) , the need for n CPAP or NIMV after failure of higher flow rate of HHHFNC (n =16, 53.3%), the need for intubation & MV (n =7, 23.3%), the incidence of nasal trauma (n =9, 30%), BPD (n =9, 30%) , IVH ≥ II (n =7, 23.3%) , NEC ≥ II (n =0), pneumothorax ( n =5, 16.6%) , pulmonary haemorrhage (n =3, 10%), death (n =3, 10%), median duration of hospitalization in days =22.5 (17-28), median duration of all oxygen support in days = 18 (15-21), so the failure rate was 17 out of 30 (56.6%). Conclusion: HHHFNC use is noninferior to other forms of noninvasive respiratory support in preterm infants for prevention of extubation failure. There were better outcomes of HHHFNC with higher gestational age and birth weight in preterm infants at either flow rates 3 or 6 L/min.

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Heated Humidified High-Flow Nasal Cannula for Prevention of Extubation Failure in Preterm Infants

Abstract: In the index study, the extubation failure rate was not statistically different between infants who were on HHHFNC or CPAP support.

Cited by 29 publications

References 24 publications

Is high-flow nasal cannula noninferior to nasal CPAP for the initial management of preterm infants?

Is high-flow nasal cannula noninferior to nasal CPAP for the initial management of preterm infants?

Nasal high flow therapy for neonates: Current evidence and future directions

The Effectiveness of the Heated Humidified High Flow Nasal Cannula as a Noninvasive Respiratory Support for Preterm Infants for Prevention of Extubation Failure

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