High-Flow Nasal Cannula Practice Patterns Reported by Neonatologists and Neonatal Nurse Practitioners in the United States

Eklund, Wakako; Scott, Patricia A.

doi:10.1097/anc.0000000000000536

Cited by 9 publications

(5 citation statements)

References 28 publications

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“…We received two comments by the survey responders that they would use a threshold FiO 2 of 30% while on humidified high flow nasal cannula (HHFNC) therapy. Recent surveys have found extensive use of HHFNC in special care nurseries in many parts of the world 32,33 . A recent large RCT concluded that HHFNC was not non‐inferior to CPAP and resulted in a higher incidence of treatment failure than CPAP when used as early respiratory support for preterm infants (>31 weeks) 34 .…”

Section: Discussionmentioning

confidence: 99%

“…Recent surveys have found extensive use of HHFNC in special care nurseries in many parts of the world. 32,33 A recent large RCT concluded that HHFNC was not non-inferior to CPAP and resulted in a higher incidence of treatment failure than CPAP when used as early respiratory support for preterm infants (>31 weeks). 34 Another RCT concluded that HHFNC is inferior to CPAP as a primary noninvasive respiratory support in preterm infants (≥28 weeks) with respiratory distress.…”

Section: Nomentioning

confidence: 99%

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A survey on criteria for intubation in moderate to late preterm infants with respiratory distress

Feng

Rao

Patole

2020

Pediatric Pulmonology

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Background: Majority of preterm infants do well with continuous positive airway pressure (CPAP) as the sole respiratory management; but some require endotracheal intubation and surfactant administration. While intubation is needed predominantly in extremely preterm infants (<28 weeks); some of the more mature preterm infants also require it. Currently, there are no clear guidelines regarding indications for endotracheal intubation in such infants. Aims: To understand the current practice regarding "criteria for intubation" in moderate to late preterm infants with respiratory distress. Methods: A survey of neonatologists in Australia New Zealand Neonatal Network (ANZNN) was conducted between April and June 2019. Results: At least one neonatologist each from 29 of the 30 tertiary ANZNN Neonatal Intensive Care Units (NICUs) responded to the survey. In total, 118/ 200 (59%) neonatologists responded. The most common criteria for intubation were CPAP = 8 cmH 2 O (61%), pH < 7.2 (55%), pCO 2 > 70 mmHg (48%), FiO 2 > 40% (40%), chest retractions (48%), more than two episodes of apnea requiring intervention (54%), and chest X-ray (CXR) showing moderate-severe hyaline membrane disease (HMD, 49%). Conclusion: While there were variations in practice, nearly 50% of the neonatologists shared a common threshold with regards to the CPAP level, FiO 2 , blood gas parameters, and clinical and radiological findings. The results of this survey will help in designing future randomized controlled trials (RCTs) on this subject.

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Section: Discussionmentioning

confidence: 99%

Section: Nomentioning

confidence: 99%

A survey on criteria for intubation in moderate to late preterm infants with respiratory distress

Feng

Rao

Patole

2020

Pediatric Pulmonology

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“…High‐flow nasal cannula (HFNC) oxygen therapy has been a popular type of noninvasive respiratory support, widely used in NICUs because it is comfortable, easy to setup, and has a low incidence of nasal trauma 7–13 . There is an increasing number of studies on the advantages, indications, and risks of using HFNC in neonates, as well as comparing its effectiveness with that of NCPAP and other noninvasive ventilation modes.…”

Section: Introductionmentioning

confidence: 99%

“…High-flow nasal cannula (HFNC) oxygen therapy has been a popular type of noninvasive respiratory support, widely used in NICUs because it is comfortable, easy to setup, and has a low incidence of nasal trauma. [7][8][9][10][11][12][13] There is an increasing number of studies on the advantages, indications, and risks of using HFNC in neonates, as well as comparing its effectiveness with that of NCPAP and other noninvasive ventilation modes. However, uncertainty surrounding the use of HFNC in the NICU remains, and cultural differences in China regarding the preferences and values of Chinese parents bring up the necessity to develop HFNC guidelines that consider Chinese culture.…”

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confidence: 99%

Guidelines for high‐flow nasal cannula oxygen therapy in neonates (2022)

Huang,

Zhao,

Hua

et al. 2023

J Evidence Based Medicine

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High‐flow nasal cannula (HFNC) oxygen therapy, which is important in noninvasive respiratory support, is increasingly being used in critically ill neonates with respiratory failure because it is comfortable, easy to setup, and has a low incidence of nasal trauma. The advantages, indications, and risks of HFNC have been the focus of research in recent years, resulting in the development of the application. Based on current evidence, we developed guidelines for HFNC in neonates using the Grading of Recommendations Assessment, Development and Evaluation (GRADE). The guidelines were formulated after extensive consultations with neonatologists, respiratory therapists, nurse specialists, and evidence‐based medicine experts. We have proposed 24 recommendations for 9 key questions. The guidelines aim to be a source of evidence and reference of HFNC oxygen therapy in clinical practice, and so that more neonates and their families will benefit from HFNC.

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“…However, CPAP has high skill requirements for nurses as the improper use would lead to adverse outcomes including nasal mucosal injury or necrosis, nasal granuloma, nasal vestibular stenosis, and nasal septum deformation or deletion in infants, and the special caps that needs to be worn for fixation to ensure ventilation effect would add discomfort for infants (2,5,6). High-flow Nasal Cannula Oxygen Therapy (HFNC), also known as Heated Humidified High Flow Nasal Cannula (HHHFNC), is a newly emerged non-invasive respiratory support technology and has been increasingly applied in NICU as an alternative to CPAP (1,(7)(8)(9)(10)(11)(12)(13). Compared with CPAP, HFNC has several merits in promoting alveolar dilation (14)(15)(16)(17)(18), improving gas exchange (14,19), protecting airway mucosa (20), and reducing respiratory work (19).…”

Section: Introductionmentioning

confidence: 99%

High-flow nasal cannula versus continuous positive airway pressure in primary respiratory support for preterm infants: A systematic review and meta-analysis

Luo

Huang²,

Xiong³

et al. 2022

Front. Pediatr.

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Respiratory support is crucial for the survival of preterm infants, and High-flow Nasal Cannula Oxygen Therapy (HFNC) and Continuous Positive Airway Pressure (CPAP) are commonly used for neonatal respiratory support. This meta-analysis aimed to compare the effects of HFNC and CPAP in primary respiratory support for preterm infants, to provide evidence-based support for clinical practice. PubMed, Embase, Cochrane Library, ClinicalTrials.gov, CNKI, VIP, WANFANG and SinoMed were searched for eligible studies. The primary outcomes included the incidence of treatment failure and the application of mechanical ventilation. A total of 27 eligible studies with 3,351 participants were included. There was no significant difference in the incidence of respiratory support failure [RR = 1.17, 95%CI (0.88–1.56)] and the application of mechanical ventilation [RR = 1.00, 95%CI (0.84–1.19)] between HFNC group and CPAP group. HFNC resulted in lower rate of air leaks [RR = 0.65, 95%CI (0.46–0.92)], nasal trauma [RR = 0.36, 95%CI (0.29–0.45)] and abdominal distension [RR = 0.39, 95%CI (0.27–0.58)], and later time of mechanical ventilation initiating [SMD = 0.60, 95%CI (0.21–0.99)], less duration of oxygen therapy [SMD = −0.35, 95%CI (−0.68 to −0.02)] and earlier enteral feeding [SMD = −0.54, 95%CI (−0.95 to −0.13)]. Alternative non-invasive respiratory support after initial treatment failure resulted in no difference in the application of mechanical ventilation between the two groups [RR = 0.99, 95%CI (0.52–1.88)]. HFNC might be more effective and safer in primary respiratory support for preterm infants. Using CPAP as a remedy for the treatment failure of HFNC could not avoid intubation. For premature infants with the gestational age <28 weeks, HFNC as primary respiratory support still needs to be further elucidated.Systematic Review Registration: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022313479, identifier: CRD42022313479.

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High-Flow Nasal Cannula Practice Patterns Reported by Neonatologists and Neonatal Nurse Practitioners in the United States

Abstract: Future Research is needed to target aspects of practice where practice variations exist, or practice is not supported by evidence. Significant practice differences related to the device types should be considered in future research design.

Cited by 9 publications

References 28 publications

A survey on criteria for intubation in moderate to late preterm infants with respiratory distress

A survey on criteria for intubation in moderate to late preterm infants with respiratory distress

Guidelines for high‐flow nasal cannula oxygen therapy in neonates (2022)

High-flow nasal cannula versus continuous positive airway pressure in primary respiratory support for preterm infants: A systematic review and meta-analysis

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