Nasal high flow in extremely preterm infants: Current evidence and practice in the United Kingdom

Diaphragm electrical activity during weaning of nasal high-flow therapy in preterm infants

“…The weaning protocol used in this study was effective, with 90% of steps successful. There is little prospective clinical evidence to guide HF weaning, therefore this protocol was based on an audit of our own unit practice and published consensus statements [4][5][6]17]. Compliance with the protocol was high suggesting it is acceptable to clinicians, and provides a framework for future clinical practice.…”

“…Following study enrolment, HF was weaned according to a prespecified protocol (figure 1). This protocol was developed using local audit data, national survey data and international consensus statements 4 6 17. Weaning steps included both flow reductions (decreasing flow by 1 L/min) and discontinuation steps (cessation of HF from 2 L/min to air or low-flow nasal cannula oxygen at <1 L/min).…”

“…Mechanisms of action include positive distending pressure, reduced nasopharyngeal resistance, and upper-airway washout to increase carbon dioxide (CO2) clearance [1]. HF is generally not recommended for primary support of respiratory distress syndrome, but is extensively used as a step-down from CPAP due to the aforementioned advantages [2][3][4].…”

“…There are few objective parameters to guide weaning of HF support in preterm infants. Weaning is largely a 'trial-and-error' process based on clinical judgement, leading to variation in practice [4][5][6].…”

“…There are few objective parameters to guide weaning of HF support in preterm infants. Weaning is largely a ‘trial-and-error’ process based on clinical judgement, leading to variation in practice 4–6. Retrospective studies have associated introduction of HF with longer duration of respiratory support and higher rates of bronchopulmonary dysplasia (BPD) 7–9.…”