Original Article
A Randomized Controlled Trial to Compare Heated Humidified High-Flow Nasal Cannulae with Nasal Continuous Positive Airway Pressure Postextubation in Premature Infants

https://doi.org/10.1016/j.jpeds.2012.11.016Get rights and content

Objective

To determine whether postextubation respiratory support via heated, humidified, high-flow nasal cannulae (HHHFNC) results in a greater proportion of infants younger than 32 weeks' gestation being successfully extubated after a period of endotracheal positive pressure ventilation compared with conventional nasal continuous positive airway pressure (NCPAP).

Study design

We randomly assigned preterm ventilated infants to Vapotherm HHHFNC or NCPAP after extubation. The primary outcome, extubation failure, was defined by prespecified failure criteria in the 7 days after extubation.

Results

A total of 132 ventilated infants younger than 32 weeks' gestation were randomized to receive either HHHFNC (n = 67) or NCPAP (n = 65). Extubation failure occurred in 15 (22%) of the HHHFNC group compared with 22 (34%) of the NCPAP group. There was no difference in the number of infants reintubated in the first week. Treatment with HHHFNC reduced the nasal trauma score 3.1 (SD 7.2) versus NCPAP 11.8 (SD 10.7), P < .001.

Conclusions

HHHFNC and NCPAP produced similar rates of extubation failure.

Section snippets

Methods

Infants were eligible for the study if they were born at less than 32 weeks' gestation, required endotracheal intubation and positive pressure ventilation, and were considered ready for extubation by the clinical team. Infants with suspected upper airway obstruction, congenital airway malformations, or major cardiopulmonary malformations were excluded. The study was approved by the Institutional Human Research Ethics Committee of Mercy Hospital for Women, Melbourne, Australia. The trial was not

Results

The numbers of infants who were eligible for the study and the numbers who were randomly assigned to either Vapotherm HHHFNC or NCPAP are shown in Figure 1. A total of 132 infants were enrolled between January 1, 2009, and July 31, 2011. All infants were followed for the first 7 days after extubation, and 121 infants were followed until their discharge home.

The baseline demographic and ventilation characteristics of enrolled infants are shown in Table I, and, with the exception of sex, were

Discussion

The rates of extubation failure were not significantly different between the HHHFNC and NCPAP groups. Overall extubation failure rates were greater in infants born at less than 28 completed weeks of gestation, 26 (44%), when compared with 28-32 weeks of gestation, 11 (15%; P < .001), which is as expected and within the range reported in the literature. There were no differences in extubation failure rates in either gestational age stratum. Distending pressure measured in the pharynx is

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    Supported by the Medical Research Foundation for Women and Babies, Melbourne, Australia (R07/40). The authors declare no conflicts of interest.

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