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      High flow nasal cannula for respiratory support in preterm infants

      Author(s): 1 , 2 , 2 , 3 , 4 , 5 , 6 , 7
      Editor(s): Cochrane Neonatal Group
      Publication date (Electronic):
      Journal: Cochrane Database of Systematic Reviews
      Publisher: Wiley

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          Abstract

          High flow nasal cannulae (HFNC) are small, thin, tapered binasal tubes that deliver oxygen or blended oxygen/air at gas flows of more than 1 L/min. HFNC are increasingly being used as a form of non-invasive respiratory support for preterm infants.

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          Research in high flow therapy: mechanisms of action.

          Kevin Dysart, Thomas L. Miller, Marla Wolfson … (2009)
          Recently, heater/humidifier devices that use novel methods to condition breathing gases from an external source have been introduced. The addition of sufficient warmth and high levels of humidification to breathing gas has allowed for higher flow rates from nasal cannula devices to be applied to patients (i.e., high flow therapy). This article provides a review of the proposed mechanisms behind the efficacy of high flow therapy via nasal cannula, which include washout of nasopharyngeal dead space, attenuation of the inspiratory resistance associated with the nasopharynx, improvement in conductance and pulmonary compliance, mild distending pressure and reduction in energy expenditure for gas conditioning.
          Article 0 comments Cited 96 times – based on 0 reviews     Review now
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            High-flow nasal cannulae in very preterm infants after extubation.

            Brett Manley, Louise S Owen, Lex Doyle … (2013)
            The use of high-flow nasal cannulae is an increasingly popular alternative to nasal continuous positive airway pressure (CPAP) for noninvasive respiratory support of very preterm infants (gestational age, <32 weeks) after extubation. However, data on the efficacy or safety of such cannulae in this population are lacking. In this multicenter, randomized, noninferiority trial, we assigned 303 very preterm infants to receive treatment with either high-flow nasal cannulae (5 to 6 liters per minute) or nasal CPAP (7 cm of water) after extubation. The primary outcome was treatment failure within 7 days. Noninferiority was determined by calculating the absolute difference in the risk of the primary outcome; the margin of noninferiority was 20 percentage points. Infants in whom treatment with high-flow nasal cannulae failed could be treated with nasal CPAP; infants in whom nasal CPAP failed were reintubated. The use of high-flow nasal cannulae was noninferior to the use of nasal CPAP, with treatment failure occurring in 52 of 152 infants (34.2%) in the nasal-cannulae group and in 39 of 151 infants (25.8%) in the CPAP group (risk difference, 8.4 percentage points; 95% confidence interval, -1.9 to 18.7). Almost half the infants in whom treatment with high-flow nasal cannulae failed were successfully treated with CPAP without reintubation. The incidence of nasal trauma was significantly lower in the nasal-cannulae group than in the CPAP group (P=0.01), but there were no significant differences in rates of serious adverse events or other complications. Although the result for the primary outcome was close to the margin of noninferiority, the efficacy of high-flow nasal cannulae was similar to that of CPAP as respiratory support for very preterm infants after extubation. (Funded by the National Health and Medical Research Council; Australian New Zealand Clinical Trials Network number, ACTRN12610000166077.).
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              High-flow nasal cannula: impact on oxygenation and ventilation in an acute lung injury model.

              Meg Frizzola, Thomas L. Miller, María Elena Herrera Rodríguez … (2011)
              High-flow nasal cannula therapy (HFNC) has been shown to be more effective than continuous positive airway pressure (CPAP) in reducing intubations and ventilator days. HFNC likely provides mechanisms to support respiratory efficiency beyond application of distending pressure. We reason that HFNC washout of nasopharyngeal dead space impacts CO(2) removal along with oxygenation. The aim of this study was to demonstrate the flow dependence of CO(2) reduction and improved oxygenation during HFNC and the dependence on leak around the nasal prongs.
              Article 0 comments Cited 25 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Title: Cochrane Database of Systematic Reviews
                Publisher: Wiley
                ISSN (Electronic): 14651858
                Publication date (Electronic): February 22 2016
                Affiliations
                [1 ]University of Oxford; Oxford Uehiro Centre for Practical Ethics; Oxford UK
                [2 ]University of Adelaide; Robinson Research Institute; Adelaide Australia
                [3 ]Women's and Children's Hospital; Department of Neonatal Medicine; 72 King William Road North Adelaide South Australia Australia 5006
                [4 ]National Maternity Hospital; Department of Neonatology; Holles Street Dublin 2 Ireland
                [5 ]Royal Hobart Hospital; Department of Paediatrics; Hobart Australia 7001
                [6 ]The Royal Women's Hospital; Neonatal Services and Newborn Research Centre; Melbourne Australia
                [7 ]The University of Melbourne; Department of Obstetrics and Gynaecology; Melbourne Australia
                Article
                DOI: 10.1002/14651858.CD006405.pub3
                PubMed ID: 26899543
                SO-VID: e725c831-1021-4717-9758-d3ba5f97ff29
                Copyright © © 2016
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