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

Abstract

Nasal continuous positive airway pressure (nCPAP) is the standard non-invasive respiratory support for newborns with respiratory distress. Nasal injury is a common problem with the interfaces used. To compare the incidence and severity of nasal injury in neonates with respiratory distress and supported on nCPAP with Hudson prong or RAM cannula with Cannulaide, a semipermeable membrane. This is an open-label, parallel-arm, gestational age-stratified, bi-centric, randomized control trial including neonates between 28 and 34 weeks gestational age and birth weight > 1000 g needing nCPAP. The size of the interface was chosen as per the manufacturer’s recommendation. Of the 229 neonates enrolled, 112 were randomized to RAM cannula with Cannulaide and 117 to Hudson prong. The baseline characteristics were similar. Any nasal injury at CPAP removal was significantly lower in the RAM cannula with Cannulaide group [6 (5.4%) vs. 31 (26.4%); risk ratio—0.77 (95% CI 0.69–0.87); p = 0.0001]. The incidence of moderate to severe nasal injury, need for mechanical ventilation within 72 h of age, duration of oxygen, and requirement of nCPAP for > 3 days were similar. For preterm infants on nCPAP, RAM cannula with Cannulaide, compared to Hudson prongs, decreases nasal injury without increasing the need for mechanical ventilation.Trail registration: CTRI/2019/03/018333, http://www.ctri.nic.in.

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 ].…”

“…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 ]. Two of the RCTs (Maram 2021 and Gokce 2021) [ 24 , 26 ] included enrolled neonates who were instituted NRS as primary respiratory support, and one (Hochwald 2021) used it both as primary and as post-extubation [ 25 ].…”

“…The reasons for the studies that were excluded are given in Supplement Table S3 [ 4 , 17 , 19 , 21 , 36 , 37 , 38 , 39 ]. The comparator in four of the six included studies was SBP [ 18 , 23 , 24 , 25 , 26 ]. In the remainder of the studies, multiple interfaces were used, including SBP [ 22 , 25 ].…”

“…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.…”