Risk factors for treatment failure of heated humidified high-flow nasal cannula as an initial respiratory support in newborn infants with respiratory distress

Lee, Won Young; Choi, Eui Kyung; Shin, Jeonghee; Lee, Eun Hee; Choi, Byung Min; Hong, Young Sook

doi:10.1016/j.pedneo.2019.09.004

Cited by 8 publications

(6 citation statements)

References 23 publications

(23 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…We also found that approximately 50% of the infants with gestational age <31 weeks, failed nHF and were stabilized with higher respiratory support, highlighting the need for cautious use of nasal flow therapy. Observed associations of nHF failure with higher levels of oxygen and lower gestational age in our study, similar to previous reports, 22,23 provide additional clinical insights to identify a selected population for application of nHF. Preterm infants with gestational age of 34 to 36 6/7 weeks and those with a prerandomization FiO 2 of 30% could be considered ideal candidates for primary nHF application.…”

Section: Discussionsupporting

confidence: 92%

Efficacy and Safety of Two Different Flow Rates of Nasal High-Flow Therapy in Preterm Neonates ≥28 Weeks of Gestation: A Randomized Controlled Trial

et al. 2021

View full text Add to dashboard Cite

Objective The study aimed to compare the efficacy and safety of two different nasal high-flow rates for primary respiratory support in preterm neonates Study Design In this single-center, double-blinded randomized controlled trial, preterm neonates ≥28 weeks of gestation with respiratory distress from birth were randomized to treatment with either increased nasal flow therapy (8–10 L/min) or standard nasal flow therapy (5–7 L/min). The primary outcome of nasal high-flow therapy failure was a composite outcome defined as the need for higher respiratory support (continuous positive airway pressure [CPAP] or mechanical ventilation) or surfactant therapy. Results A total of 212 neonates were enrolled. Nasal high-flow failure rate in the increased flow group was similar to the standard flow group (22 vs. 29%, relative risk = 0.81 [95% confidence interval: 0.57–1.15]). However, nasal flow rate escalation was significantly more common in the standard flow group (64 vs. 43%, p = 0.004). None of the infants in the increased flow group developed air leak syndromes. Conclusion Higher nasal flow rate (8–10 L/min) when compared with lower nasal flow rate of 5 to 7 L/min did not reduce the need for higher respiratory support (CPAP/mechanical ventilation) or surfactant therapy in moderately and late preterm neonates. However, initial flow rates of 5 L/min were not optimal for most preterm infants receiving primary nasal flow therapy. Key Points

show abstract

Section: Discussionsupporting

confidence: 92%

Efficacy and Safety of Two Different Flow Rates of Nasal High-Flow Therapy in Preterm Neonates ≥28 Weeks of Gestation: A Randomized Controlled Trial

et al. 2021

View full text Add to dashboard Cite

show abstract

“…Immaturity of lung tissue and weakness of respiratory muscles will worsen the condition of RDS in preterm patients and present a high risk of the development of bronchopulmonary dysplasia (BPD) making it difficult to wean off of oxygen therapy. 13,14 Our study found that age at the start of weaning of less than 4 days, although statistically significant, was a protective factor for HFNC weaning failure (OR 0.289; 95%CI 0.111 to 0.752; P=0.016). Study on the relationship between the timing of starting HFNC weaning and HFNC failure has so far not been established.…”

Section: Discussionmentioning

confidence: 61%

“…The study showed that the group with failed HFNC tended to require a higher setting of FiO 2 to maintain oxygen saturation at 88-94% than the HFNC successful group [35 (SD 0.06) % vs. 25 (SD 0.06) %; P=0.001] with a cutoff FiO 2 setting of 28% based on the ROC curve (sensitivity 89.7% and specificity 69.1%). 13 Another retrospective study also demonstrated that subjects requiring FiO 2 >35% were at a significant risk for HFNC therapy failure in preterm infants <32 weeks with RDS. The study found that preterm infants <32 weeks with FiO 2 >35% had a 3.9 times greater risk of HFNC therapy failure (OR 3,911; 95%CI 1,639 to 9,333; P=0.002).…”

Section: Discussionmentioning

confidence: 97%

See 1 more Smart Citation

Risk factors contributing to weaning failure from continuous positive airway pressure to high flow nasal cannula in neonates with respiratory distress syndrome

Putra,

Dadiyanto,

Sahyuni

et al. 2024

View full text Add to dashboard Cite

Background Respiratory distress syndrome (RDS) is one of the most frequent causes of mortality and morbidity in neonates. High flow nasal canule (HFNC) is a step ladder modality of alternative oxygen therapy for weaning to reduce the workload of breathing and the need for intubation. Objective To identify the risk factors contributing to weaning failure from continuous positive airway pressure (CPAP) to HFNC in neonates with RDS. Methods This study was a retrospective observational study in neonates aged less than 36 weeks weighing less than 2500 grams who underwent CPAP to HFNC weaning from 2019 to 2021 in Dr. Kariadi Hospital, Semarang, Central Java, Indonesia. Results There were 108 patients included in this study. Our bivariate analysis found significant differences in gestational age, age at the start of weaning, body weight at the start of weaning, FiO2 levels, history of maternal chorioamnionitis, patent ductus arteriosus (PDA), anemia, apnea of prematurity (AOP), and sepsis in neonates with RDS. Multivariate analysis showed that the most dominant factors were FiO2 levels of more than 25% at the start of weaning (OR11.16; 95%CI 1.83 to 63.12; P=0.009), anemia (OR 7.70; 95%CI 1.39 to 42.67; P=0.019), AOP (OR 19.64; 95%CI 4.27 to 90.35; P<0.001), and sepsis (OR 10.93; 95%CI 2.37 to 45.53; P=0.002) Conclusion FiO2 setting of more than 25% at the start of weaning, anemia, AOP, and sepsis produce a significant probability of HFNC weaning failure.

show abstract

“…For instance, CPAP failure has been reported to occur in over 40% of infants with a gestational age (GA) below 29 weeks [ 8 , 9 ]. Similarly, Lee et al reported a 30% HFNC failure in a cohort of infants (n = 97) with a GA > 30 weeks, who eventually required other types of NRS or mechanical ventilation [ 10 ]. These preterm infants usually receive intratracheal surfactant later in the course of RDS, when the benefits of therapy may be attenuated compared with the early surfactant administration [ 11 ].…”

Section: Introductionmentioning

confidence: 99%

Preclinical Assessment of Nebulized Surfactant Delivered through Neonatal High Flow Nasal Cannula Respiratory Support

et al. 2022

View full text Add to dashboard Cite

High-flow nasal cannula (HFNC) is a non-invasive respiratory support (NRS) modality to treat premature infants with respiratory distress syndrome (RDS). The delivery of nebulized surfactant during NRS would represent a truly non-invasive method of surfactant administration and could reduce NRS failure rates. However, the delivery efficiency of nebulized surfactant during HFNC has not been evaluated in vitro or in animal models of respiratory distress. We, therefore, performed first a benchmark study to compare the surfactant lung dose delivered by commercially available neonatal nasal cannulas (NCs) and HFNC circuits commonly used in neonatal intensive care units. Then, the pulmonary effect of nebulized surfactant delivered via HFNC was investigated in spontaneously breathing rabbits with induced respiratory distress. The benchmark study revealed the surfactant lung dose to be relatively low for both types of NCs tested (Westmed NCs 0.5 ± 0.45%; Fisher & Paykel NCs 1.8 ± 1.9% of a nominal dose of 200 mg/kg of Poractant alfa). The modest lung doses achieved in the benchmark study are compatible with the lack of the effect of nebulized surfactant in vivo (400 mg/kg), where arterial oxygenation and lung mechanics did not improve and were significantly worse than the intratracheal instillation of surfactant. The results from the present study indicate a relatively low lung surfactant dose and negligible effect on pulmonary function in terms of arterial oxygenation and lung mechanics. This negligible effect can, for the greater part, be explained by the high impaction of aerosol particles in the ventilation circuit and upper airways due to the high air flows used during HFNC.

show abstract

Risk factors for treatment failure of heated humidified high-flow nasal cannula as an initial respiratory support in newborn infants with respiratory distress

Cited by 8 publications

References 23 publications

Efficacy and Safety of Two Different Flow Rates of Nasal High-Flow Therapy in Preterm Neonates ≥28 Weeks of Gestation: A Randomized Controlled Trial

Efficacy and Safety of Two Different Flow Rates of Nasal High-Flow Therapy in Preterm Neonates ≥28 Weeks of Gestation: A Randomized Controlled Trial

Risk factors contributing to weaning failure from continuous positive airway pressure to high flow nasal cannula in neonates with respiratory distress syndrome

Preclinical Assessment of Nebulized Surfactant Delivered through Neonatal High Flow Nasal Cannula Respiratory Support

Contact Info

Product

Resources

About