RAM cannula with Cannulaide versus Hudson prongs for delivery of nasal continuous positive airway pressure in preterm infants: an RCT

Shravani Maram,Saikiran Deshobhotla,Deepak Sharma,Subhash Arun,Sandeep Kadam,Tejo Pratap Oleti,Srinivas Murki,Praveen Rao Vadije,Sidharth Nayyar,Rajendra Prasad Anne

doi:10.1038/s41598-021-02988-4

Abstract

Nasal continuous positive airway pressure (nCPAP) is the standard non-invasive respiratory support for newborns with respiratory distress. Nasal injury is a common problem with the interfaces used. To compare the incidence and severity of nasal injury in neonates with respiratory distress and supported on nCPAP with Hudson prong or RAM cannula with Cannulaide, a semipermeable membrane. This is an open-label, parallel-arm, gestational age-stratified, bi-centric, randomized control trial including neonates between 28 and 34 weeks gestational age and birth weight > 1000 g needing nCPAP. The size of the interface was chosen as per the manufacturer’s recommendation. Of the 229 neonates enrolled, 112 were randomized to RAM cannula with Cannulaide and 117 to Hudson prong. The baseline characteristics were similar. Any nasal injury at CPAP removal was significantly lower in the RAM cannula with Cannulaide group [6 (5.4%) vs. 31 (26.4%); risk ratio—0.77 (95% CI 0.69–0.87); p = 0.0001]. The incidence of moderate to severe nasal injury, need for mechanical ventilation within 72 h of age, duration of oxygen, and requirement of nCPAP for > 3 days were similar. For preterm infants on nCPAP, RAM cannula with Cannulaide, compared to Hudson prongs, decreases nasal injury without increasing the need for mechanical ventilation.Trail registration: CTRI/2019/03/018333, http://www.ctri.nic.in.

Highlights

Nasal continuous positive airway pressure is the standard non-invasive respiratory support for newborns with respiratory distress
The characteristics of respiratory illness including the severity of respiratory distress, number of infants with respiratory distress syndrome, surfactant requirement, age at enrolment, F iO2 at enrolment, CPAP at enrolment, maximum F iO2 required, maximum CPAP required, and age at receiving surfactant were similar between Hudson prong and RAM cannula with Cannulaide groups (Table 2)
Thirty one infants (26.4%) in Hudson prong group and 6 infants (5.35%) in RAM cannula with Cannulaide group had nasal injury (RR—0.77, 95% CI 0.69–0.87, p = 0.0001; Absolute risk reduction—0.21, 95% CI 0.12–0.3; Number need to prevent one injury—4.7, 95% CI 3.32–8.26)

Summary

Introduction

Nasal continuous positive airway pressure (nCPAP) is the standard non-invasive respiratory support for newborns with respiratory distress. To compare the incidence and severity of nasal injury in neonates with respiratory distress and supported on nCPAP with Hudson prong or RAM cannula with Cannulaide, a semipermeable membrane. For preterm infants on nCPAP, RAM cannula with Cannulaide, compared to Hudson prongs, decreases nasal injury without increasing the need for mechanical ventilation. Hudson prongs (Hudson-RCI, Temecula, CA) were designed to reduce the nasal trauma associated with the delivery of infant nCPAP They are soft, anatomically curved prongs available in 6 sizes, allowing greater choices for appropriate sizing. To a traditional nasal cannula used to deliver oxygen, but its stiffer design allows a higher flow rate and pressure delivery As it is made of a soft material, there is lower airflow resistance and a tendency for reduced nasal trauma

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