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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
Author(s) -
Latremouille Samantha,
Shalish Wissam,
Kanbar Lara,
Lamer Philippe,
Rao Smita,
Kearney Robert E.,
Sant'Anna Guilherme M.
Publication year - 2019
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.24284
Subject(s) - medicine , nasal cannula , anesthesia , continuous positive airway pressure , heart rate variability , gestational age , crossover study , heart rate , randomized controlled trial , respiratory rate , intensive care , cannula , surgery , intensive care medicine , blood pressure , pregnancy , obstructive sleep apnea , alternative medicine , pathology , biology , genetics , placebo
Abstract 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.