Evidence Support and Guidelines for Using Heated, Humidified, High-Flow Nasal Cannulae in Neonatology

Roehr, Charles Christoph; Yoder, Bradley A.; Davis, Peter G; Ives, Kevin

doi:10.1016/j.clp.2016.07.006

Cited by 33 publications

(44 citation statements)

References 59 publications

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“…Second, the results of randomized controlled trials comparing NCPAP with HFNC for the prevention of extubation failure have been inconclusive for infants less than 28 weeks gestation . Despite that, an increasing number of units across the world have adopted HFNC as first line therapy post‐extubation in these infants . Thus, it is imperative to develop a better understanding of the physiological effects of HFNC and NCPAP during the critical post‐extubation period.…”

Section: Discussionmentioning

confidence: 93%

“…As such, the less consistent intrapharyngeal pressure delivered with HFNC may theoretically disadvantage the most immature infants. Second, the results of randomized controlled trials comparing NCPAP with HFNC for the prevention of extubation failure have been inconclusive for infants less than 28 weeks gestation . Despite that, an increasing number of units across the world have adopted HFNC as first line therapy post‐extubation in these infants .…”

Section: Discussionmentioning

confidence: 99%

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The effects of nasal continuous positive airway pressure and high flow nasal cannula on heart rate variability in extremely preterm infants after extubation: A randomized crossover trial

Latremouille

Shalish

Kanbar³

et al. 2019

Pediatric Pulmonology

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Background NCPAP and High flow nasal cannula (HFNC) are common modes of non‐invasive respiratory support used after extubation. Heart rate variability (HRV) has been demonstrated as a marker of well‐being in neonates and differences in HRV were described in preterm infants receiving respiratory care. The objective was to investigate the effects of NCPAP and HFNC on HRV after extubation. Methods Randomized crossover trial in infants with birth weight (BW) ≤1250 g after undergoing their first elective extubation. ECG recordings were performed during 45 min while on HFNC and nasal continuous positive airway pressure (NCPAP). Time domain, non‐linear, and frequency domain parameters were calculated and compared during HFNC and NCPAP using paired nonparametric tests. A secondary analysis was performed in the subgroup of infants that were successfully extubated. Results Thirty infants with median [range] gestational age of 27 weeks [24.1‐29.3] and BW of 930 g [610‐1220] were studied at 5 days [1‐39] of age. No differences in HRV parameters were observed between HFNC and NCPAP. In the secondary analysis, infants successfully extubated (n = 27) had a significantly higher HRV during HFNC for some time domain parameters. For instance, the standard deviation of the RR intervals (SDRR) was more likely to be higher during HFNC compared to NCPAP (HFNC: 18/27 vs NCPAP: 9/27, P = 0.017) . Conclusion During the first hours after extubation, no differences in HRV were detected between HFNC and NCPAP in the overall cohort. However, a significantly higher HRV was noted during HFNC in the subgroup of infants successfully extubated.

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Section: Discussionmentioning

confidence: 93%

Section: Discussionmentioning

confidence: 99%

The effects of nasal continuous positive airway pressure and high flow nasal cannula on heart rate variability in extremely preterm infants after extubation: A randomized crossover trial

Latremouille

Shalish

Kanbar³

et al. 2019

Pediatric Pulmonology

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“…For the purpose of consistency of our clinical management, we have persisted with the use of nHFT for more than a decade in both centres. Details of the use of nHFT in relation to nCPAP have recently been published [16]. Both centres, however, occasionally use nCPAP in infants < 28 weeks (at their clinician’s discretion), and therefore this GA group was not included.…”

Section: Methodsmentioning

confidence: 99%

“…nHFT seems to be better tolerated [15, 16]. Consequently, the use of nHFT has expanded significantly: around 77% of surveyed units in the UK reported the use of nHFT in 2013 [17].…”

Section: Introductionmentioning

confidence: 99%

Nasal High-Flow Therapy as Primary Respiratory Support for Preterm Infants without the Need for Rescue with Nasal Continuous Positive Airway Pressure

et al. 2018

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Aim: To evaluate the effectiveness of nasal high-flow therapy (nHFT) as primary respiratory support for preterm infants with respiratory distress syndrome (RDS) in two tertiary neonatal units. Methods: A retrospective outcome analysis of initial respiratory support strategies was performed in two tertiary neonatal units in the UK: John Radcliffe Hospital (JRH), Oxford and St Peter’s Hospital (SPH), Chertsey. Infants born between 28⁺⁰ and 36⁺⁶ weeks gestational age (GA) between May 2013 and June 2015 were included. Results: A total of 381 infants, 191 from JRH and 190 from SPH, were analysed. Infants were stabilised in the delivery room using mask continuous positive airway pressure followed by nHFT. Endotracheal intubation was performed according to local protocols, depending on the severity of RDS. There were significant differences in initial intubation rates according to GA (26% JRH vs. 16.9% SPH, p < 0.001 for babies < 32 weeks GA, and 8.2% JRH vs. 6.5% SPH, p < 0.001 for babies > 32 weeks GA); however, most infants were successfully transitioned to nHFT. Intubation rates during the first 72 h were comparable between centres (14.7% JRH vs. 11.1% SPH, p = 0.29). There were no differences in neonatal morbidities, including air leak, duration of oxygen supplementation, bronchopulmonary dysplasia, sepsis, retinopathy of prematurity, intraventricular haemorrhage, necrotising enterocolitis, or median time to full-suck feeds. Conclusion: Use of nHFT for primary respiratory support, without use of nasal continuous positive airway pressure as “rescue” treatment, resulted in intubation rates lower or comparable to published data from randomised controlled trials.

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“…With HFNC, heated/humidified gas is delivered to the nostrils with nasal catheters that are specifically designed not to occlude the nostrils, typically at flows of between 2 and 8 L/min, with weaning of flow rate determined clinically by FiO 2 remaining low and judgement of work of breathing [101]. Whilst an amount of pressure is invariably generated within the nasopharynx, the primary mode of action probably relates to gas conditioning and nasopharyngeal dead space CO 2 washout.…”

Section: Non-invasive Respiratory Supportmentioning

confidence: 99%

European Consensus Guidelines on the Management of Respiratory Distress Syndrome – 2019 Update

et al. 2019

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As management of respiratory distress syndrome (RDS) advances, clinicians must continually revise their current practice. We report the fourth update of “European Guidelines for the Management of RDS” by a European panel of experienced neonatologists and an expert perinatal obstetrician based on available literature up to the end of 2018. Optimising outcome for babies with RDS includes prediction of risk of preterm delivery, need for appropriate maternal transfer to a perinatal centre and timely use of antenatal steroids. Delivery room management has become more evidence-based, and protocols for lung protection including initiation of CPAP and titration of oxygen should be implemented immediately after birth. Surfactant replacement therapy is a crucial part of management of RDS, and newer protocols for its use recommend early administration and avoidance of mechanical ventilation. Methods of maintaining babies on non-invasive respiratory support have been further developed and may cause less distress and reduce chronic lung disease. As technology for delivering mechanical ventilation improves, the risk of causing lung injury should decrease, although minimising time spent on mechanical ventilation using caffeine and, if necessary, postnatal steroids are also important considerations. Protocols for optimising general care of infants with RDS are also essential with good temperature control, careful fluid and nutritional management, maintenance of perfusion and judicious use of antibiotics all being important determinants of best outcome.

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Evidence Support and Guidelines for Using Heated, Humidified, High-Flow Nasal Cannulae in Neonatology

Cited by 33 publications

References 59 publications

The effects of nasal continuous positive airway pressure and high flow nasal cannula on heart rate variability in extremely preterm infants after extubation: A randomized crossover trial

The effects of nasal continuous positive airway pressure and high flow nasal cannula on heart rate variability in extremely preterm infants after extubation: A randomized crossover trial

Nasal High-Flow Therapy as Primary Respiratory Support for Preterm Infants without the Need for Rescue with Nasal Continuous Positive Airway Pressure

European Consensus Guidelines on the Management of Respiratory Distress Syndrome – 2019 Update

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