Review finds insufficient evidence to support the routine use of heated, humidified high‐flow nasal cannula use in neonates

Shetty, Sandeep; Greenough, Anne

doi:10.1111/apa.12695

Cited by 16 publications

(7 citation statements)

References 32 publications

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“…Recently, high-flow nasal cannula therapy (HFNC) has become a popular alternative [15]. However, investment and training in new equipment is expensive, and concerns persist regarding the safety of HFNC (risk of pneumothorax or pneumomediastinum and nosocomial infection) and the potential for delay in initiating invasive ventilation for high-risk children [16–20]. …”

Section: Introductionmentioning

confidence: 99%

Non-invasive respiratory support for infants with bronchiolitis: a national survey of practice

et al. 2017

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BackgroundBronchiolitis is a common respiratory illness of early childhood. For most children it is a mild self-limiting disease but a small number of children develop respiratory failure. Nasal continuous positive airway pressure (nCPAP) has traditionally been used to provide non-invasive respiratory support in these children, but there is little clinical trial evidence to support its use. More recently, high-flow nasal cannula therapy (HFNC) has emerged as a novel respiratory support modality. Our study aims to describe current national practice and clinician preferences relating to use of non-invasive respiratory support (nCPAP and HFNC) in the management of infants (<12 months old) with acute bronchiolitis.MethodsWe performed a cross-sectional web-based survey of hospitals with inpatient paediatric facilities in England and Wales. Responses were elicited from one senior doctor and one senior nurse at each hospital. We analysed the proportion of hospitals using HFNC and nCPAP; clinical thresholds for their initiation; and clinician preferences regarding first-line support modality and future research.ResultsThe survey was distributed to 117 of 171 eligible hospitals; 97 hospitals provided responses (response rate: 83%). The majority of hospitals were able to provide nCPAP (89/97, 91.7%) or HFNC (71/97, 73.2%); both were available at 65 hospitals (67%). nCPAP was more likely to be delivered in a ward setting in a general hospital, and in a high dependency setting in a tertiary centre. There were differences in the oxygenation and acidosis thresholds, and clinical triggers such as recurrent apnoeas or work of breathing that influenced clinical decisions, regarding when to start nCPAP or HFNC. More individual respondents with access to both modalities (74/106, 69.8%) would choose HFNC over nCPAP as their first-line treatment option in a deteriorating child with bronchiolitis.ConclusionsDespite lack of randomised trial evidence, nCPAP and HFNC are commonly used in British hospitals to support infants with acute bronchiolitis. HFNC appears to be currently the preferred first-line modality for non-invasive respiratory support due to perceived ease of use.Electronic supplementary materialThe online version of this article (doi:10.1186/s12887-017-0785-0) contains supplementary material, which is available to authorized users.

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Section: Introductionmentioning

confidence: 99%

Non-invasive respiratory support for infants with bronchiolitis: a national survey of practice

et al. 2017

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“…[14][15][16] Several clinical trials over the last decade have collected evidence of the use of HHHFNC in preterm infants, both as a primary mode of support at birth and after extubation from MV. We conducted a systematic review and metaanalysis to collect all published information, to be able to guide clinical practice.…”

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confidence: 99%

Safety and Efficacy of High-Flow Nasal Cannula Therapy in Preterm Infants: A Meta-analysis

et al. 2015

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BACKGROUND AND OBJECTIVE: High-flow therapy is the most recent, and popular, mode of respiratory support in neonates. However, the evidence supporting its efficacy and safety has not yet been established. We conducted a systematic review and meta-analysis of clinical trials comparing efficacy and safety of high-flow therapy compared with other modes of noninvasive ventilation (NIV) in preterm infants.METHODS: Articles were indexed by using Medline, Embase, Scopus, OpenSIGLE, Health Management Information Consortium, and Cochrane Central Register of Controlled Trials. Randomized or quasirandomized clinical trials involving preterm infants, comparing high-flow therapy with other modes of NIV, and reporting extractable data on relevant outcomes, were selected. Data on efficacy, safety, and other common neonatal outcomes were extracted on predesigned forms. RESULTS:In this analysis, we included 1112 preterm infants, participating in 9 clinical trials. High-flow therapy was similar in efficacy to other modes of NIV in preterm infants when used as primary support (odds ratio of failure of therapy, 1.02 [95% confidence interval: 0.55 to 1.88]), as well as after extubation (1.09 [0.58 to 2.02]). There were no significant differences in odds of death (0.48 [0.18 to 1.24]) between the groups. Preterm infants supported on highflow had significantly lower odds of nasal trauma (0.13 [0.02 to 0.69]).CONCLUSIONS: High-flow therapy appears to be similar in efficacy and safety to other conventional modes of NIV in preterm infants. It is associated with significantly lower odds of nasal trauma. Caution needs to be exercised in extreme preterm infants because of the paucity of published data.

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“…Giving the perceived benefit of HHHFNC compared with nCPAP in deceasing pain and discomfort, does not necessarily mean that we should shift from using nCPAP to HHHFNC in preterm infants requiring respiratory support until the safety and efficacy of HHHFNC is proven in adequately randomized-controlled trials. 36 We acknowledge that there are limitations to this study like small sample size, lack of double-blind randomized controls and lack of data on baseline salivary-cortisol concentrations. Further, adequately powered randomized-controlled trials are required to compare the pain response on using different nCPAP systems and interfaces.…”

Section: Discussionmentioning

confidence: 97%

Assessment of pain during application of nasal-continuous positive airway pressure and heated, humidified high-flow nasal cannulae in preterm infants

2014

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Review finds insufficient evidence to support the routine use of heated, humidified high‐flow nasal cannula use in neonates

Abstract: There is insufficient evidence to support the routine use of HHFNC for premature infants and further research is required.

Cited by 16 publications

References 32 publications

Non-invasive respiratory support for infants with bronchiolitis: a national survey of practice

Non-invasive respiratory support for infants with bronchiolitis: a national survey of practice

Safety and Efficacy of High-Flow Nasal Cannula Therapy in Preterm Infants: A Meta-analysis

Assessment of pain during application of nasal-continuous positive airway pressure and heated, humidified high-flow nasal cannulae in preterm infants

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