Early weaning from CPAP to high flow nasal cannula in preterm infants is associated with prolonged oxygen requirement: A randomized controlled trial

Abdel‐Hady, Hesham; Shouman, Basma; Aly, Hany

doi:10.1016/j.earlhumdev.2010.12.010

Cited by 104 publications

(108 citation statements)

References 20 publications

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“…Abdel-Hady et al [32] randomised 60 preterm infants (≥28 weeks’ gestation) who were stable on NCPAP at 5 cm H 2 O with fraction of inspired oxygen <0.30 for at least 24 h into two groups. The NCPAP group was kept on NCPAP until they required no supplemental oxygen for 24 h and then placed in air.…”

Section: Clinical Uses Of Hfnc In Preterm Infantsmentioning

confidence: 99%

High-Flow Nasal Cannulae for Respiratory Support of Preterm Infants: A Review of the Evidence

Manley¹,

Dold

Davis³

et al. 2012

Neonatology

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Background: High-flow nasal cannulae (HFNC) are gaining in popularity as a form of non-invasive respiratory support for preterm infants in neonatal intensive care units around the world. They are proposed as an alternative to nasal continuous positive airway pressure (NCPAP) in a variety of clinical situations, including post-extubation support, primary therapy from birth and ‘weaning’ from NCPAP. Objectives: To present and discuss the available evidence for the use of HFNC in the preterm population. Methods: An internet-based literature search for relevant, original research articles (both randomised studies and not) on the use of HFNC in preterm infants was undertaken. Results: A total of 19 studies were included in the review. Distending pressure generated by HFNC in preterm infants increases with increasing flow rate and decreasing infant size and varies according to the amount of leak around the prongs. HFNC may be as effective as NCPAP at improving respiratory parameters such as tidal volume and work of breathing in preterm infants, but probably only at flow rates >2 litres/min. The efficacy and safety of HFNC in preterm infants remain to be determined. Conclusions: There is growing evidence of the feasibility of HFNC as an alternative to other forms of non-invasive ventilation in preterm infants. However, there remains uncertainty about the efficacy and safety of HFNC in this population. Until the results of larger randomised trials are known, widespread use of HFNC to treat preterm infants cannot be recommended.

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Section: Clinical Uses Of Hfnc In Preterm Infantsmentioning

confidence: 99%

High-Flow Nasal Cannulae for Respiratory Support of Preterm Infants: A Review of the Evidence

Manley¹,

Dold

Davis³

et al. 2012

Neonatology

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“…However, recent randomized controlled trials have shown that HHHFNC is either as effective or is noninferior to CPAP in the prevention of extubation failure [6,7,8]. HHHFNC has also been used as a primary respiratory support in apnea of prematurity, respiratory distress syndrome and as a weaning method from CPAP [9,10,11,12]. …”

Section: Introductionmentioning

confidence: 99%

“…A study by Todd et al [17] showed that weaning time when weaning directly from CPAP was shorter than that using low-flow nasal cannula during a cycling time-off period. Of 2 studies using HHHFNC for weaning off CPAP, 1 concluded that using HHHFNC prolonged oxygen supplementation and the duration of respiratory support [9], but the other had contradictory results [18]. Since methods of how to wean from CPAP are still controversial, we therefore conducted a study to compare the time to achieve this successfully between weaning directly from CPAP and weaning by HHHFNC.…”

Section: Introductionmentioning

confidence: 99%

Heated Humidified High-Flow Nasal Cannula for Weaning from Continuous Positive Airway Pressure in Preterm Infants: A Randomized Controlled Trial

Soonsawad

Tongsawang²,

Nuntnarumit³

2016

Neonatology

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Background: Heated humidified high-flow nasal cannula (HHHFNC) therapy has been widely used in preterm infants. However, evidence to support its use as a continuous positive airway pressure (CPAP) weaning method is still controversial. Objectives: We aimed to compare time to wean directly off CPAP vs. weaning by using HHHFNC. Methods: Infants with a gestational age (GA) of <32 weeks who met the predefined criteria for weaning off CPAP, i.e. with a CPAP of ≤6 cm H₂O and a fraction of inspired oxygen (FiO₂) of ≤0.3 for at least 24 h, were randomly assigned to wean by using HHHFNC or wean directly from CPAP. In the HHHFNC group, flow rate was reduced by 1 liter/min every 24 h to 2-3 liters/min depending on body weight (i.e. < or ≥1,000 g), and then HHHFNC was discontinued. In the CPAP group, pressure was reduced by 1 cm H₂O every 24 h until stable on CPAP 4 cm H₂O and then discontinued. The primary outcome was the time it took to wean off the use of the CPAP or HHHFNC devices. Results: One-hundred and one infants were enrolled, 51 in the HHHFNC and 50 in the CPAP group. Both groups had similar demographics and respiratory conditions before enrollment. There was no difference in time to successfully wean between the 2 groups [median (IQR): 11 (4-21) days in the HHHFNC group vs. 11 (4-29) days in the CPAP group; p = 0.12]. There were no differences in morbidities or related complications. Infants in the HHHFNC group had significantly less nasal trauma (20 vs. 42%; p = 0.01). Conclusions: In our study, the time to wean off CPAP using HHHFNC was not different from when weaning directly from CPAP.

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“…112 In those trials comparing HFNC therapy to nasal CPAP, the clinical context for its use varies: as an alternative to CPAP post-extubation, 106 as support for respiratory distress instead of CPAP, 113 and in weaning off CPAP. 114 Yet, some studies only report the physiological effects of HFNC 13,82,99 Due to the heterogeneity of outcome measures and interventions, a meta-analysis was inappropriate. The overall conclusion was that there was insufficient evidence to determine the safety and efficacy of HFNC therapy compared to other forms of respiratory support for premature infants.…”

Section: Hfnc Therapy In Pre-term To Term Neonatesmentioning

confidence: 99%

“…Despite all these reviews demonstrating an increasing use of HFNC therapy in nurseries , more recent studies demonstrate that heated and humidified HFNC systems are the norm 65,99,110,115,116,[121][122][123][124][125][126] , and as such should be considered in any future study design.…”

mentioning

confidence: 99%

Evidence for the use of high flow nasal cannula therapy for respiratory management in paediatric units

Mayfield¹

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Early weaning from CPAP to high flow nasal cannula in preterm infants is associated with prolonged oxygen requirement: A randomized controlled trial

Cited by 104 publications

References 20 publications

High-Flow Nasal Cannulae for Respiratory Support of Preterm Infants: A Review of the Evidence

High-Flow Nasal Cannulae for Respiratory Support of Preterm Infants: A Review of the Evidence

Heated Humidified High-Flow Nasal Cannula for Weaning from Continuous Positive Airway Pressure in Preterm Infants: A Randomized Controlled Trial

Evidence for the use of high flow nasal cannula therapy for respiratory management in paediatric units

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