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A randomized pilot study comparing heated humidified high‐flow nasal cannulae with NIPPV for RDS
Author(s) -
Kugelman Amir,
Riskin Arieh,
Said Waseem,
Shoris Irit,
Mor Frida,
Bader David
Publication year - 2015
Publication title -
pediatric pulmonology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.866
H-Index - 106
eISSN - 1099-0496
pISSN - 8755-6863
DOI - 10.1002/ppul.23022
Subject(s) - medicine , nasal cannula , bronchopulmonary dysplasia , necrotizing enterocolitis , respiratory distress , gestational age , anesthesia , continuous positive airway pressure , intraventricular hemorrhage , retinopathy of prematurity , pediatrics , surgery , cannula , pregnancy , biology , obstructive sleep apnea , genetics
Summary Objective To compare the requirement for endotracheal ventilation in preterm infants treated with heated, humidified high‐flow nasal cannula (HHHFNC) with those treated with nasal intermittent positive pressure ventilation (NIPPV) for the primary treatment of respiratory distress syndrome (RDS). Study Design Randomized, controlled, prospective, single‐center pilot study. Infants (gestational age [GA] <35 weeks, birth weight [BW] >1,000 g) with RDS were randomly assigned to receive HHHFNC (38 infants) delivered by Vapotherm® device (Precision Flow™ or 2000i, Vapotherm Inc., Stevensville, MD), at flows between 1.0 and 5.0 L/min, or NIPPV (38 infants) delivered by the SLE 2000 or 5000. Surfactant was administered as rescue therapy. Analysis was done by intention‐to‐treat. Results Infant's characteristics ([mean ± SD] GA 31.8 ± 2.3 vs. 32.0 ± 2.3 weeks) and cardio‐respiratory status at study entry (FiO 2 0.25 ± 0.05 vs. 0.26 ± 0.07; SpO 2 90 ± 6% vs. 87 ± 12; PCO 2 54.4 ± 10.4 vs. 52.6 ± 8.0 mmHg) were comparable for the HHHFNC and NIPPV groups. There was no significant difference in the need for endotracheal ventilation (28.9% vs. 34.2%) between HHHFNC and NIPPV groups. One infant failed HHHFNC and succeeded on NIPPV. The rate of neonatal morbidities (pneumothorax, bronchopulmonary dysplasia, intra‐ventricular hemorrhage, necrotizing enterocolitis, patent ductus arteriosus, and nasal trauma) was comparable in both groups. Duration of nasal support was longer with HHHFNC compared with NIPPV (5.4 ± 4.0 vs. 2.6 ± 1.9 days, P = 0.006) but the duration of endotracheal ventilation, time to full feeds, and length of stay were comparable. Conclusions Our pilot study suggests that HHHFNC maybe as effective as NIPPV in preventing endotracheal ventilation in the primary treatment of RDS in premature infants (<35 weeks GA and BW >1,000 g). Pediatr Pulmonol. 2015; 50:576–583. © 2014 Wiley Periodicals, Inc.