Positive Airway Pressure Versus High-Flow Nasal Cannula for Prevention of Extubation Failure in Infants After Congenital Heart Surgery*

Abstract

Objectives: Compare the impact of initial extubation to positive airway pressure versus high-flow nasal cannula on postoperative outcomes in neonates and infants after congenital heart surgery. Design: Retrospective cohort study with propensity-matched analysis. Setting: Cardiac ICU within a tertiary care children’s hospital. Patients: Patients less than 6 months old initially extubated to either high-flow nasal cannula or positive airway pressure after cardiac surgery with cardiopulmonary bypass were included (July 2012 to December 2015). Interventions: None. Measurements and Main Results: Of 258 encounters, propensity matching identified 49 pairings of patients extubated to high-flow nasal cannula versus positive airway pressure. Extubation failure was 12% for all screened encounters. After matching, there was no difference in extubation failure rate between groups (positive airway pressure 16% vs high-flow nasal cannula 10%; p = 0.549). However, compared with high-flow nasal cannula, patients initially extubated to positive airway pressure experienced greater resource utilization: longer time to low-flow nasal cannula (83 vs 28 hr; p = 0.006); longer time to room air (159 vs 110 hr; p = 0.013); and longer postsurgical hospital length of stay (22 vs 14 d; p = 0.015). Conclusions: In this pediatric cohort, primary extubation to positive airway pressure was not superior to high-flow nasal cannula with respect to prevention of extubation failure after congenital heart surgery. Compared with high-flow nasal cannula, use of positive airway pressure was associated with increased hospital resource utilization. Prospective initiatives aimed at establishing best clinical practice for postoperative noninvasive respiratory support are needed.

Nasal high flow therapy introduction lowers reintubation risk in a Peruvian paediatric intensive care unit

“…The pre‐ and post‐implementation study designs of the quoted studies suggest that temporal changes in care delivery, such as implementing a standardised extubation process in our study, may explain differences in reintubation rates. Other paediatric studies have shown no difference in extubation failure rates for preterm infants 29 or infants after cardiac surgery 30 who received HFNT or CPAP for post‐extubation respiratory failure. Together, these data suggest that HFNT and CPAP may provide comparable support for post‐extubation respiratory failure.…”

Bilevel Positive Airway Pressure Versus Nasal Continuous Positive Airway Pressure for Prevention of Extubation Failure in Infants After Cardiac Surgery: A Randomized Controlled Trial

“…Extubation failure after congenital heart surgery is associated with prolonged hospital stay and mortality [23]. Studies have shown that BiPAP could reduce the need for reintubation, especially in patients with respiratory failure and cardiogenic pulmonary edema [24][25].…”

Pediatric High Flow Nasal Cannula Experience in a Tertiary Care Hospital in Saudi Arabia

“…Schibler et al conducted a retrospective analysis in all infants admitted to PICU, requiring HFNC between 2005 and 2009, showed an overall reduction in the intubation rate to 7% compared to their local registry [9]. When comparing HFNC to noninvasive ventilation in post extubated infants who underwent congenital heart surgery, there was no statistical difference in the reintubation rate [40]. In adults, a multicenter randomized control trial was conducted in adult patients admitted to ICU with hypoxic respiratory failure.…”

“…It compared the rate of intubation among patients receiving conventional oxygen therapy, HFNC, and NIV. It showed no significant difference in the outcome, but showed significant 90 days mortality reduction in the group treated with HFNC [40]. A meta-analysis done by Zhao, H et al comparing HFNC with conventional oxygen therapy and NIV, showed that HFNC is associated with a reduction in intubation rate when compared to conventional oxygen therapy (COT) but not to noninvasive ventilation (NIV) [41].…”