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Neonatal high-flow nasal cannula therapy safe, effective
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A systematic review of the safety and efficacy of high-flow nasal cannula therapy on preterm infants revealed that the treatment is equally safe and effective as other methods of noninvasive ventilation.
“Respiratory failure, requiring invasive support with mechanical ventilation or noninvasive support with nasal modes of ventilation, remains the most common morbidity of preterm infants after birth,” Sarah J. Kotecha, BSc, SRD, of the department of child health at Cardiff University, United Kingdom, and colleagues wrote. “High-flow therapy appears to be similar in efficacy and safety to other conventional modes of noninvasive ventilation in preterm infants.”
To assess the safety and efficacy of heated humidified high-flow nasal cannula therapy in preterm infants, the researchers analyzed data from previous studies. Nine clinical trials, including 1,112 preterm infants, were studied.
Results showed that high-flow nasal cannula therapy was similar in efficacy to all other forms of noninvasive ventilation studied, including nasal continuous positive airway pressure and noninvasive positive pressure ventilation, when used as the primary means of support (OR for therapy failure = 1.02; 95% CI, 0.55-1.88).
The researchers also found that high-flow nasal cannula therapy was just as safe as other forms of noninvasive ventilation, with no significant difference in mortality reported (OR = 0.48; 95% CI, 0.18-1.24). In fact, the therapy was found to reduce the odds of nasal trauma in preterm infants on mechanical ventilation (OR = 0.13; 95% CI, 0.02-0.69).
The researchers emphasized that the mode of respiratory support for neonates should be determined on a case-by-case basis, dependent on the patient’s needs.
“Because of the physiology of the lungs in early respiratory distress syndrome, the continuous distending pressure provided by nasal continuous positive airway pressure, in theory, could make it more suitable as a mode of respiratory support than heated humidified high-flow nasal cannula,” Kotecha and colleagues wrote. “Caution needs to be exercised in extreme preterm infants because of the paucity of published data.” – by David Costill
Disclosure: The researchers report no relevant financial disclosures.
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