Optiflow vs Vapotherm as extended weaning mode from nasal continuous positive airway pressure in preterm infants ≤ 28 weeks gestational age

Abstract

Introduction Current evidence supports nasal continuous positive airway pressure (NCPAP) weaning. Heated humidified high‐flow nasal cannula (HHFNC) reduces NCPAP time in infants less than 28 weeks gestational age (GA) without increasing morbidity. The aim of the study was to compare the two most frequently used HHFNC devices in weaning from NCPAP. Methodology We performed a retrospective matched‐pair case‐control study of infants less than or equal to 28 GA born in a single tertiary neonatal center managed with Optiflow or Vapotherm after being weaned from NCPAP. Patients were matched for antenatal steroid doses, delivery mode, birth plurality, GA, birthweight, gender, surfactant doses, length of mechanical ventilation, and length of NCPAP. Outcome measures were duration of HHFNC, low‐flow nasal cannula, nasal bridge lesions, pneumothorax, bronchopulmonary dysplasia, postnatal steroids, necrotizing enterocolitis, sepsis, intraventricular hemorrhage, retinopathy of prematurity, length of stay, discharge weight, and mortality. Results were displayed as median (interquartile range) or ratio (percentage). Statistical analysis was performed using Mann‐Whitney U and χ2 tests. Results 70 patients were recruited retrospectively. Thirty‐five infants were weaned from NCPAP to Optiflow and 35 infants to Vapotherm with gestational ages and birthweights of 27 GA (26‐27) and 1010 g (835‐1165) and 27 GA (26‐28) and 960 g (788‐1191), respectively. There was no statistically significant difference in any outcome measure. Infants managed with Vapotherm required a not statistically significant shorter length of time on HHFNC and low‐flow nasal cannula. Conclusions Optiflow and Vapotherm seem to be equally effective and safe for weaning from NCPAP. However, infants weaned to Vapotherm appear to spend less time on non‐invasive respiratory support.

Stabilisation of the preterm infant in the delivery room using nasal high flow: A 5—year retrospective analysis

“…None of these studies have included extreme preterm babies. A recent review compared the use of HF devices after weaning CPAP 29 and found no significant differences; our report uses HF as a primary treatment, and we would be cautious about extrapolating this result. With increasing use of HF for neonatal respiratory support at different stages of a baby's clinical course, 30 there remains a need for further evaluation on the use of HF in the DR.…”

Comparison of the effectiveness of different high-flow devices in neonatal care

“…These findings are consistent with previous studies that have reported successful HFNC weaning from NIV. 8 , 9 , 10 , 11 HFNC has been shown to be a safe and effective alternative to NIV in preterm infants, with similar rates of adverse events and no significant difference in the duration of supplemental oxygen or hospital discharge. 8 , 9 , 10 , 11 The authors previously demonstrated a 30 % rate of nasal injury resulting from the NIV interface, and this was the main reason for using HFNC for weaning 22 .…”

“… 8 , 9 , 10 , 11 HFNC has been shown to be a safe and effective alternative to NIV in preterm infants, with similar rates of adverse events and no significant difference in the duration of supplemental oxygen or hospital discharge. 8 , 9 , 10 , 11 The authors previously demonstrated a 30 % rate of nasal injury resulting from the NIV interface, and this was the main reason for using HFNC for weaning 22 . The reduction in nasal injury and improved patient tolerance of HFNC compared to NIV make it an attractive option for managing neonates who require continuous positive pressure support.…”

“…`There are a number of applications for neonatal HFNC therapy. Clinical situations in which HFNC is being used in neonatology include primary respiratory therapy, 12 , 13 , 14 prematurity apnea, 2 weaning from CPAP, 8 , 9 , 10 , 11 and prevention of extubation failure. 4 , 5 , 6 This aligns with the results which showed high extubation success rates with HFNC therapy.…”

“…Like traditional methods of non-invasive ventilation (NIV), such as nasal intermittent positive pressure ventilation (IPPV) or continuous positive airway pressure (CPAP), HFNC may prevent extubation failure in preterm infants with respiratory distress syndrome (RDS), 4 , 5 , 6 thereby reducing the risk of complications such as Bronchopulmonary Dysplasia, sepsis, neurological injury, and retinopathy of prematurity. 7 Additionally, HFNC has emerged as a strategy for weaning from NIV 8 , 9 , 10 , 11 and as a primary ventilatory support in preterm infants. 12 , 13 , 14 However, to ensure its efficacy and safety in preterm infants with different gestational ages and clinical conditions, further studies are needed.…”