High flow nasal cannula for respiratory support in preterm infants

Abstract

There is insufficient evidence to establish the safety or effectiveness of HFNC as a form of respiratory support in preterm infants. When used following extubation, HFNC may be associated with a higher rate of reintubation than nasal CPAP. Further adequately powered randomised controlled trials should be undertaken in preterm infants comparing HFNC with nasal CPAP and with other means of respiratory support; or of support following extubation. These trials should measure clinically important outcomes.

Rapid systematic review shows that using a high‐flow nasal cannula is inferior to nasal continuous positive airway pressure as first‐line support in preterm neonates

“…The confirmation of this result in the sensitivity analysis indicated the robustness of this finding. These data are in contrast with those obtained from meta-analyses of HFNC initiated after extubation, which have consistently shown that the efficacy is similar to NCPAP (12,13).…”

Rapid systematic review shows that using a high‐flow nasal cannula is inferior to nasal continuous positive airway pressure as first‐line support in preterm neonates

“…The confirmation of this result in the sensitivity analysis indicated the robustness of this finding. These data are in contrast with those obtained from meta-analyses of HFNC initiated after extubation, which have consistently shown that the efficacy is similar to NCPAP (12,13).…”

Heated Humidified High-Flow Nasal Cannula for Preterm Infants: An Updated Systematic Review and Meta-analysis

“…However, we found that meta-analysis of adverse event rates from studies indicates statistically significantly fewer adverse events with HHHFNC than with NCPAP as measured by air leak (for the post-extubation analysis) and nasal trauma (for both the post-extubation analysis and analysis of primary respiratory support). The reduced incidence in nasal trauma identified by our review is one of the expected benefits of HHHFNC, as previously reported by the authors of two meta-analyses (39;40). A statistically significant reduction in air leak has not, however, been previously demonstrated by meta-analysis.…”

“…Our updated literature search identified an additional twelve stud- (39). Our update has not found any consistent and statistically significant differences between HHHFNC and NCPAP (or NIPPV) for the majority of efficacy outcomes, including the primary outcome of treatment failure; similar findings have been reported from previous metaanalyses (9;39;40).…”

Effect of High-Flow Nasal Cannula on Expiratory Pressure and Ventilation in Infant, Pediatric, and Adult Models

“…One study showed that HFNC increased both PEEP and end-expiratory lung volume, providing evidence that HFNC can recruit collapsed alveoli. 28 The PEEPs observed in our models correlate well with those reported in infants 1,28,29 and adults, 11,[30][31][32] with the exception of 2 studies using adult nasopharyngeal models 9,33 that we attribute to model differences. Thus, the current study contributes to the growing body of evidence that HFNC generates PEEP.…”

Rapid systematic review shows that using a high‐flow nasal cannula is inferior to nasal continuous positive airway pressure as first‐line support in preterm neonates

“…The confirmation of this result in the sensitivity analysis indicated the robustness of this finding. These data are in contrast with those obtained from meta-analyses of HFNC initiated after extubation, which have consistently shown that the efficacy is similar to NCPAP (12,13).…”

Heated Humidified High-Flow Nasal Cannula for Preterm Infants: An Updated Systematic Review and Meta-analysis

“…However, we found that meta-analysis of adverse event rates from studies indicates statistically significantly fewer adverse events with HHHFNC than with NCPAP as measured by air leak (for the post-extubation analysis) and nasal trauma (for both the post-extubation analysis and analysis of primary respiratory support). The reduced incidence in nasal trauma identified by our review is one of the expected benefits of HHHFNC, as previously reported by the authors of two meta-analyses (39;40). A statistically significant reduction in air leak has not, however, been previously demonstrated by meta-analysis.…”

“…Our updated literature search identified an additional twelve stud- (39). Our update has not found any consistent and statistically significant differences between HHHFNC and NCPAP (or NIPPV) for the majority of efficacy outcomes, including the primary outcome of treatment failure; similar findings have been reported from previous metaanalyses (9;39;40).…”

Effect of High-Flow Nasal Cannula on Expiratory Pressure and Ventilation in Infant, Pediatric, and Adult Models

“…One study showed that HFNC increased both PEEP and end-expiratory lung volume, providing evidence that HFNC can recruit collapsed alveoli. 28 The PEEPs observed in our models correlate well with those reported in infants 1,28,29 and adults, 11,[30][31][32] with the exception of 2 studies using adult nasopharyngeal models 9,33 that we attribute to model differences. Thus, the current study contributes to the growing body of evidence that HFNC generates PEEP.…”

Rapid systematic review shows that using a high‐flow nasal cannula is inferior to nasal continuous positive airway pressure as first‐line support in preterm neonates

“…The confirmation of this result in the sensitivity analysis indicated the robustness of this finding. These data are in contrast with those obtained from meta-analyses of HFNC initiated after extubation, which have consistently shown that the efficacy is similar to NCPAP (12,13).…”

Heated Humidified High-Flow Nasal Cannula for Preterm Infants: An Updated Systematic Review and Meta-analysis

“…However, we found that meta-analysis of adverse event rates from studies indicates statistically significantly fewer adverse events with HHHFNC than with NCPAP as measured by air leak (for the post-extubation analysis) and nasal trauma (for both the post-extubation analysis and analysis of primary respiratory support). The reduced incidence in nasal trauma identified by our review is one of the expected benefits of HHHFNC, as previously reported by the authors of two meta-analyses (39;40). A statistically significant reduction in air leak has not, however, been previously demonstrated by meta-analysis.…”

“…Our updated literature search identified an additional twelve stud- (39). Our update has not found any consistent and statistically significant differences between HHHFNC and NCPAP (or NIPPV) for the majority of efficacy outcomes, including the primary outcome of treatment failure; similar findings have been reported from previous metaanalyses (9;39;40).…”

Effect of High-Flow Nasal Cannula on Expiratory Pressure and Ventilation in Infant, Pediatric, and Adult Models

“…One study showed that HFNC increased both PEEP and end-expiratory lung volume, providing evidence that HFNC can recruit collapsed alveoli. 28 The PEEPs observed in our models correlate well with those reported in infants 1,28,29 and adults, 11,[30][31][32] with the exception of 2 studies using adult nasopharyngeal models 9,33 that we attribute to model differences. Thus, the current study contributes to the growing body of evidence that HFNC generates PEEP.…”