Heated Humidified High-flow Nasal Cannula Research Articles

Heated Humidified High Flow Nasal Cannula for Non-Invasive Primary Respiratory Support in Neonates: Experience of a Referral Neonatal Level III Facility in South-South Nigeria

Background: Heated humidified high flow nasal cannula (HHHFNC) is an increasingly used tool for non-invasive ventilation (NIV) in neonates and children needing advanced respiratory support.1 In neonates, common indications for HHHFNC therapy include: respiratory distress syndrome (RDS), post extubation from mechanical ventilation; and other causes of respiratory distress. Its use in Nigeria is not widespread. The aim of this study is to assess the indications, clinical characteristics, outcome and determinants of the successful use of HHHFNC for providing primary respiratory support for neonates referred and needing NIV in a Level III NICU in Nigeria. Methods: This was a retrospective study. All neonates in this study were referred to our facility, Med-Vical Medical Centre, Benin City, Edo State, Nigeria and received HHHFNC for primary respiratory support. Results: The highest indication for primary use of HHHFNC for neonates was respiratory distress syndrome (50.0%). The success rate of HHHFNC in this study was high (70.0%). Although not statistically significant, a higher proportion of neonates in the failure group weighed less than 1kg, while in the successful group, a higher proportion was delivered after 28 weeks. All infants who stayed longer than 7days on admission belonged to the successful group, and none failed HHHFNC therapy. This difference was statistically significant (p=0.011). In conclusion, this study revealed that the success rate of HHHFNC therapy as primary respiratory support in neonates with respiratory distress is high (70.0%), thus it can be used confidently in neonates needing NIV. Length of hospital stay was the only significant factor associated with the successful use of HHHFNC as primary respiratory support.

Weaning off heated humidified high flow nasal cannula successfully in a 24-week extreme low birth weight infant in South-South Nigeria: a case report

The use of heated humidified high flow nasal cannula (HHHFNC) has become increasingly popular for providing noninvasive respiratory support for neonates with respiratory distress syndrome (RDS). However, there are several challenges to its use as primary respiratory support in extreme low birth weight (ELBW) preterm infants delivered before 28 weeks gestational age (GA), these include: lack of established guideline; and conflicting reports from studies on the risk of respiratory failure (apnea), necrotizing enterocolitis (NEC), bronchopulmonary dysplasia (BPD) and death. In Nigeria, HHHFNC is not widely known nor used in most neonatal care facilities, including level III Neonatal care facilities. Despite adequate literature search, there is little or no known report or guideline for the successful use of and weaning from HHHFNC in ELBW neonates, delivered before 28 weeks GA in the Country. We present the successful weaning from HHHFNC as primary respiratory support at 30 weeks post conception age (PCA) in an ELBW preterm infant (weighing 700 gm) with severe RDS, delivered at 24 weeks GA in a neonatal care facility in Nigeria. HHHFNC was commenced at 6l/min following surfactant administration and successfully weaned off at 2l/min at 30 weeks PCA, with no incidence of apnea, BPD, NEC, air leaks, nasal septum damage and death. HHHFNC used as noninvasive primary respiratory support for ELBW preterm neonates with severe RDS delivered before 28 weeks GA is effective and safe; in addition, weaning off HHHFNC in this group of infants at 30 weeks PCA should be explored and recommended as a guideline in Nigeria and globally.

Nasal High-Frequency Oscillatory Ventilation Use in Romanian Neonatal Intensive Care Units-The Results of a Recent Survey.

Nasal high-frequency oscillatory ventilation (nHFOV) has emerged as an effective initial and rescue noninvasive respiratory support mode for preterm infants with respiratory distress syndrome (RDS); however, little is known about nHFOV use in Romanian neonatal intensive care units (NICUs). We aimed to identify the usage extent and clinical application of nHFOV in Romania. A structured web-based questionnaire was designed to find the rate of nHFOV use and knowledge of this new method of noninvasive respiratory support in Romanian level III NICUs. Using multiple-choice, open-ended, and yes/no questions, we collected information on the NICU's size, noninvasive respiratory support modes used, nHFOV use, indications, settings, nasal interfaces, secondary effects, and equipment used. Descriptive statistics and comparisons were performed using IBM SPSS Statistics 26.0. A total of 21/23 (91.3%) leaders from level III NICUs (median [IQR] number of beds of 10 [10-17.5]) responded to the survey. The most frequently used noninvasive ventilation modes were CPAP mode on mechanical ventilators (76.2%), followed by NIPPV (76.2%); heated, humidified high-flow nasal cannula (HHHFNC) (61.9%); and nHFOV (11/21 units; 52.4%). A total of 5/11 units reported frequent nHFOV use (in two or more newborns/month) in both term and preterm infants. The main indications reported for nHFOV use were CPAP failure (90.9%), hypercapnia (81.8%), and bronchopulmonary dysplasia (72.7%). Face/nasal masks and short binasal prongs are the most commonly used nasal interfaces (90.9% and 72.7%, respectively). Air leaks at the interface level (90.9%), thick secretions (81.8%), and airway obstruction (63.6%) were the most frequently mentioned adverse effects of nHFOV. Only three of the NICUs had a written protocol for nHFOV use. Most units not yet using nHFOV cited lack of equipment, experience, training, or insufficient information and evidence for the clinical use and outcome of nHFOV use in neonates as the main reasons for not implementing this noninvasive respiratory mode. Our survey showed that nHFOV is already used in more than half of the Romanian level III NICUs to support term and preterm infants with respiratory distress despite a lack of consensus regarding indications and settings during nHFOV.

Changes in the patterns of respiratory support and incidence of bronchopulmonary dysplasia; a single center experience

BackgroundWith the advances in neonatal intensive care, the survival rate of extremely preterm infants is increasing. However, bronchopulmonary dysplasia (BPD) remains a major cause of morbidity among infants in this group. This study examined the changes in respiratory support modalities, specifically heated humidified high-flow nasal cannula (HHHFNC), and their association with BPD incidence among preterm infants born at < 29 weeks of gestation.MethodThis population-based retrospective cohort study included infants born at < 29 weeks of gestation between 2016 and 2020. Data regarding the use and duration of respiratory support modalities were obtained, including mechanical ventilation, continuous positive airway pressure, HHHFNC, and low-flow oxygen therapy. Additionally, the incidence of BPD was determined in the included infants. Trend analysis for each respiratory support modality and BPD incidence rate was performed to define the temporal changes associated with changes in BPD rates. In addition, a logistic regression model was developed to identify the association between BPD and severity grade using HHHFNC.ResultsThree Hundred and sixteen infants were included in this study. The use and duration of HHHFNC therapy increased during the study period. Throughout the study period, the overall incidence of BPD was 49%, with no significant trends. The BPD rate was significantly higher in the infants who received HHHFNC than in those who did not (52% vs. 39%, P = 0.03). Analysis of BPD severity grades showed that both grade 1 BPD (34% vs. 21%, P = 0.03) and grade 2 BPD (12% vs. 1%, P < 0.01) were significantly more common among infants who received HHHFNC than among those who did not. In contrast, the incidence of grade 3 BPD was lower in infants who received HHFNC (6% vs. 17%, P < 0.01). The duration in days of HHHFNC was found to significantly predict BPD incidence (OR 1.04 [95%CI: 1.01–1.06], P < 0.01) after adjusting for confounding variables.ConclusionThe use of HHHFNC in extremely preterm infants born at < 29 weeks of gestation is increasing. There was a significant association between the duration of HHHFNC therapy and the development of BPD in extremely preterm infants born at < 29 weeks of gestation.

Effect of Nasal Continuous Positive Airway Pressure vs Heated Humidified High-Flow Nasal Cannula on Feeding Intolerance in Preterm Infants With Respiratory Distress Syndrome

Respiratory distress syndrome and feeding intolerance are common conditions that are often associated with preterm infants. Showing similar efficacy, nasal continuous positive airway pressure (NCPAP) and heated humidified high-flow nasal cannula (HHHFNC) are the most widespread noninvasive respiratory support (NRS) in neonatal intensive care units, but their effect on feeding intolerance is unknown. To evaluate the effect of NCPAP vs HHHFNC on high-risk preterm infants with respiratory distress syndrome. This multicenter randomized clinical trial involved infants who were born in 1 of 13 neonatal intensive care units in Italy between November 1, 2018, and June 30, 2021. Preterm infants with a gestational age of 25 to 29 weeks, who were suitable for enteral feeding and who proved to be medically stable on NRS for at least 48 hours were enrolled in the study within the first week of life and randomized to receive either NCPAP or HHHFNC. Statistical analysis was performed according to the intention-to-treat approach. NCPAP or HHHFNC. The primary outcome was the time to full enteral feeding (FEF), defined as an enteral intake of 150 mL/kg per day. Secondary outcomes were the median daily increment of enteral feeding, signs of feeding intolerance, effectiveness of the assigned NRS, peripheral oxygen saturation (SpO2)-fraction of inspired oxygen (FIO2) ratio at changes of NRS, and growth. Two-hundred forty-seven infants (median [IQR] gestational age, 28 [27-29] weeks; 130 girls [52.6%]) were randomized to the NCPAP group (n = 122) or the HHHFNC group (n = 125). There were no differences in the primary and secondary nutritional outcomes between the 2 groups. The median time to reach FEF was 14 days (95% CI, 11-15 days) in the NCPAP group and 14 days (95% CI, 12-18 days) in the HHHFNC group, and similar results were observed in the subgroup of infants with less than 28 weeks' gestation. On the first NRS change, higher SpO2-FIO2 ratio (median [IQR], 4.6 [4.1-4.7] vs 3.7 [3.2-4.0]; P < .001) and lower rate of ineffectiveness (1 [4.8%] vs 17 [73.9%]; P < .001) were observed in the NCPAP vs HHHFNC group. This randomized clinical trial found that NCPAP and HHHFNC had similar effects on feeding intolerance, despite different working mechanisms. Clinicians may tailor respiratory care by selecting and switching between the 2 NRS techniques on the basis of respiratory effectiveness and patient compliance, without affecting feeding intolerance. ClinicalTrials.gov Identifier: NCT03548324.

How to choose between high-flow nasal cannula, continuous positive airway pressure, and bilevel positive airway pressure in children with acute respiratory illness

In pediatric patients with acute respiratory illnesses, the widespread availability of heated humidified high-flow nasal cannula (HHHFNC) devices, ease of use, and increased compliance have increased their use in conditions such as pneumonia, acute respiratory failure, asthma, and acute respiratory distress syndrome. Due to the patient comfort and ease of use of HHHFNC, there are widely used. Similarly, the use of NIV is increasing due to the availability of better interfaces and non-invasive ventilators (NIV) for use in infants The conundrum has been regarding the generation of positive end-expiratory pressure in these open circuits of the HHHFNC devices versus the pressures delivered by the closed circuits in the NIV devices. This article reviewed the latest literature based on the clinical conditions and the rationale for selecting respiratory support in common acute respiratory illnesses.

Acute Bronchiolitis in Term Newborns Following Relaxation in COVID-19 Appropriate Behavior

Abstract Objective Neonatal bronchiolitis is not well characterized. We studied the profile of acute bronchiolitis in term newborns during a respiratory syncytial virus (RSV) surge following relaxation in coronavirus disease 2019 (COVID-19) appropriate behavior. Methods This was a retrospective descriptive study performed in the neonatology division of a tertiary care pediatric hospital at Srinagar, Jammu and Kashmir, India. Term neonates (born at ≥37 completed gestational weeks) from 7 up to 28 days of life admitted with bronchiolitis over a 1-month period (November 2021) were included. Results Out of total 480 neonatal admissions over a month, 35 (7%) had acute bronchiolitis. Eight neonates were excluded. Out of 27 included neonates, 13 were males. Mean age at presentation was 20 days. All neonates were born at term (≥37 completed gestational weeks). Cough (26), rapid breathing (20), and lower chest indrawing (20) were the predominant presenting features. Median SPO2 was 87% (interquartile range 85–92%). Fourteen (52%) neonates needed admission to neonatal intensive care unit. Respiratory support was needed in the form of oxygen through nasal prongs in 24 (89%) newborns. Heated humidified high-flow nasal cannula (HHHFNC) and bubble continuous positive airway pressure were used in five neonates each. Two neonates were mechanically ventilated. The mean duration of the hospital stay was 6.2 days. All neonates survived. Conclusion A series of 27 term neonates with bronchiolitis during an RSV surge is reported in the aftermath of lifting of COVID-19 restrictions. Many of these neonates were sick enough to require significant respiratory support. The outcome was good in all neonates.

Advances in Management of Respiratory Failure in Children.

Providing the right respiratory support is an essential skill, vital for anyone treating sick children. Recent advances in respiratory support include developments in both non-invasive and invasive ventilatory strategies. In non-invasive ventilation, newer modalities are being developed, in an attempt to decrease the need for invasive ventilation. This include newer techniques like Heated humidified high-flow nasal cannula (HHHFNC) and improvements in existing modes. The success of Continuous positive airway pressure (CPAP) and other non-invasive modes depend to a large extent on choosing and maintaining a suitable interface. When it comes to invasive ventilation, recent advances are focussing on increasing automation, improving patient comfort and minimising lung injury. Concepts like mechanical power are attempts at understanding the mechanisms of unintended injuries resulting from respiratory support and newer monitoring methods like transpulmonary pressure, thoracic impedance tomography are attempts at measuring potential markers of lung injury. Using the vast arrays of available ventilatory options judiciously, considering their advantages and drawbacks in every individual case will be the prime responsibility of clinicians in the future. Simultaneously, efforts have been made to identify potential drugs that can favourably modify the pathophysiology of acute respiratory distress syndrome (ARDS). Unfortunately, though eagerly awaited, most pharmaceutical agents tried in pediatric ARDS have not shown definite benefit. Pulmonary local drug and gene therapy using liquid ventilation strategies may revolutionize our future understanding and management of lung diseases.

A randomized controlled trial to compare the success rates and efficacy of high flow nasal cannulae versus nasal continuous positive airway pressure in post extubation period in neonates

Background: Nasal continuous positive airway pressure (nCPAP) is the mainstay for non-invasive respiratory support for all respiratory distress neonates. Recent advances in Heated humidified high flow nasal cannula (HHHFNC) usage with enhanced humidity, and improved comfort factors have led to its widespread use, at times replacing nCPAP in many neonatal settings. The present study was to assess the efficacy and safety of HHHFNC compared with nCPAP for non-invasive respiratory support in post-extubation period. Methods: A hospital based randomized controlled trial was conducted in neonatal intensive care unit (NICU) of S. Nijalingappa Medical College and HSK Hospital, Bagalkot from January 2019 to June 2020. 140 post-extubated neonates were enrolled for the study after obtaining informed consent from parents, and those who were directly extubated to no support and with major congenital anomalies were excluded from the study. Randomization was done by computer generated random number allocation method. Results: Of the140 babies, 60% were males and 40% were females. Out of 84 male neonates, 47 (67.1%) were on nCPAP and 37 (32.9%) on HHHFNC and out of 56 female neonates 23 (32.9%) were on nCPAP and 33 (47.1%) on HFNC. In this study, 4 babies on nCPAP required re-intubation within 72 hours. 5 babies on HHHFNC, 3 babies required re-intubation within 72 hours and 2 babies within 5 days. The incidence of nasal trauma, hospital stay and duration of NIV support were less in HHHFNC group as compared to nCPAP group. Conclusions: HHHFNC therapy is as effective as nCPAP therapy for the facilitation of extubation in neonates.

Incidence of nasal trauma in nasal continuous positive airway pressure versus heated humidified high flow nasal cannula in neonates, our experience in Government Medical College Srinagar

Background: The nCPAP (nasal continuous positive airway pressure) is noninvasive mode of ventilation that decreases the need for mechanical ventilation in neonates. The newer device heated humidified high flow nasal cannula (HHHFNC) delivers heated (to body temperature, 37 °C) and humidified (near 100% relative humidity) gas at flow rates of more than 1 liter/min through small bi-nasal prongs, that is more physiological. Methods: This was a retrospective study conducted in neonatal intensive care unit. The eligible neonates who were put on HHHFNC or nCPAP depending upon the availability of any of these devices at the time of admission. The details regarding complications were recorded from the admission files of these patients from medical record section of the hospital. Results: There was no statistically significant difference in complications like shock, NEC, pulmonary air leak, apnea, PDA, ROP, IVH or PVL for nCPAP or HHHFNC. However, nasal trauma was present in 18 (18%) patients in nCPAP group but in no patient in HHHFNC. Conclusions: There is no significant differences in complication in nCPAP vs HHHFNC except nasal trauma which is more common in nCPAP.

Noise Levels of Invasive and Non Invasive Respiratory Support used in Neonatal Intensive Care Unit of Northern India: A Cross-sectional Study

Introduction: The average noise level exposure inside Neonatal Intensive Care Unit (NICU) is more than the recommended guidelines. The source of noise exposure inside NICU is multifactorial. There is need of studies to assess the noise levels of respiratory equipment used inside the NICU. Aim: To assess the noise levels of invasive versus non invasive and respiratory support in preterm neonates admitted to NICU. Materials and Methods: This cross-sectional descriptive study was done in NICU of a tertiary health care center of Sanjay Gandhi Postgraduate Institute, Lucknow, Uttar Pradesh, India over one year duration from December 2019 to December 2020. A sample of 85 eligible neonates without major congenital anomalies (26- 36+6 weeks gestation) was enroled in this study after obtaining informed consent from parents. The noise levels of Heated Humidified High Flow Nasal Cannula (HHHFNC), Continuous Positive Airway Pressure (CPAP), conventional ventilation and High-Frequency Ventilation (HFV) were measured using a sound level meter for a period of first 24 hours of life. The median sound level from non invasive ventilation is compared with invasive ventilation. The continuous variables were expressed as median with range, while categorical data were expressed as frequencies and percentages. Results: A total of 85 neonates were enroled majority of them were born in 32-34 weeks of gestation and were with birth weight of 1501-2500 grams. The sound level exposure of HHHFNC support was 56.1 dB (52.6-60 dB) from warmer and 47.3 dB (44.6-50.8 dB) from the incubator. The median sound level exposure per hour of bubble CPAP was 59 dB (55.2-61.9 dB) with warmer and 51.4 dB (47-55 dB) with incubator. The median sound level exposure per hour of the conventional ventilator was 60 dB (57.4-63.9 dB) with warmer and 53 dB (50.2-56.1 dB) with incubator. The median sound level exposure per hour of high-frequency ventilator was 69.1 dB (66.3-71.8 dB) with warmer and 67.3 dB (66.2-68.9 dB) with incubator. Conclusion: Non invasive ventilation (HHHFNC and bubble CPAP) was less noisy than invasive ventilation. The lowest measured noise exposure was higher than the American Academy of Paediatrics (AAP) recommendation of 45 dB, even after isolation with physical barrier.

Delivery Room Respiratory Stabilization of Preterm Neonates: A Randomized, Controlled Trial.

To determine whether heated humidified high-flow nasal cannula (HHHFNC) is noninferior to NCPAP to provide DR respiratory support to preterm neonates of gestational age (GA) 28-36 wk. This randomized, controlled, noninferiority trial included 124 spontaneously breathing preterm neonates who developed respiratory distress soon after birth and/or had a FiO2 requirement > 0.3. Primary outcome measure was treatment failure within 24h. The absolute risk difference with 95% confidence interval (CI) were calculated with a noninferiority margin of 10%. Secondary outcome variables were temperature at admission, time to treatment failure, treatment failure at 72h, need for surfactant, intubation, duration of respiratory support, and incidences of adverse events including mortality. Intention-to-treat analysis was done in Stata software. Both the groups were similar in baseline characteristics. There was no statistically significant difference between the treatment failure rates with HHHFNC (13.1%, n = 61) and NCPAP (11.1%, n = 63) (risk difference 2.0%, 95% CI - 9.9% to 14.07%, p = 0.73). However, noninferiority of HHHFNC to NCPAP could not be conclusively proved as the 95% CI crossed both 0 and the noninferiority margin of 10%. There were no significant differences in secondary outcomes. HHHFNC showed similar efficacy and safety as NCPAP irrespective of gestational age, though its noninferiority to NCPAP remained inconclusive. Clinical Trial Registry of India, Registration no: CTRI/2019/10/021633, https://ctri.icmr.org.in/.

Efficacy of Nasal Continuous Positive Airway Pressure versus Heated Humidified High-Flow Nasal Cannula as a Primary Mode of Respiratory Support in Preterm Infants with RDS

Objective: To determine the efficacy of nasal continuous positive airway pressure (NCPAP) versus heated humidified high-flow nasal cannula (HHHFNC) as a primary mode of respiratory support in preterm infants with respiratory distress. Methodology: This randomized controlled trial study was conducted at in-patient department of neonatology (Nursery &amp; NICU) of Pakistan Insitute of Medical Sciences (PIMS) from July 2020 to Dec 2020. A total of 280 neonates randomly divided (140 in each study group) of both genders, with gestational age between 28-34 weeks and having mild-to-moderate respiratory distress within 1st 6 hours of birth requiring non-invasive ventilation were enrolled. Neonates in NCPAP Group (n=140) were given NCPAP whereas neonates in HHHFNC Group (n=140) were given HHHFNC. The efficacy of both groups were compared on the basis of treatment failure within 1st 3 days, total duration (hours) of non-invasive ventilator (NIV) required and total duration (hours) of supplementary oxygen required. Results: Overall, mean gestational age was noted to be 30.0+6.4 weeks. There were 144 (51.4%) neonates with birth weight between 1 to 1.4 kg, 90 (32.1%) between 1.5 to 1.9 kg and 46 (16.4%0 between 2.0 to 2.4 kg. Treatment failure was noted in 67 (47.6%) neonates in NCAP group while HHHFNC group reported 73 (52.4%) neonates with treatment failure (p=0.4733). No significant difference was observed in mean total duration of NIV support required (p=0.2598) or mean total duration of supplementary oxygen (p=0.1946) in between study groups. Conclusion: HHHFNC had similar efficacy when compared to NCPAP among neonates with RDS. In comparison to NCPAP, HHHFNC could be a simple, well-tolerated and effective alternative in terms of respiratory support. No major difference in terms of complication was observed between both treatment approaches.

Comparison between Continuous positive Airway Pressure (CPAP) and High Flow Nasal Cannula (HFNC) in Management of Bronchiolitis and community acquired pneumonia in Infants and Young Children

Abstract Background Acute respiratory failure develops in infants with bronchiolitis and Community acquired pneumonia (CAP) because of hypoxemia, due to mismatch between ventilation and perfusion. Nasal continuous airway pressure (nCPAP) and high-flow nasal cannula (HFNC) improve the work of breathing and oxygenation .High flow nasal cannula (HFNC), also called heated humidified high flow nasal cannula (HHHFNC), is a new non-invasive ventilation therapy that seems to be well tolerated in infants with hypoxemic respiratory failure. Aim To compare the effectiveness and the outcome of Heated Humidified High Flow Nasal Cannula (HFNC) versus Nasal Continuous Positive Airway Pressure (NCPAP), as a primary mode of respiratory support, in patients with respiratory failure due to pneumonia or bronchiolitis at PICU regarding demographic data, length of admission, increasing of positive pressure and need of intubation. Patients and Methods observational study was conducted on 40 patients with acute respiratory failure due to either bronchiolitis or community acquired pneumonia (CAP), admitted to Paediatric ICU, Children Hospital, Ain Shams University, in the time period between February 2018 to July 2019. The patients, aged between 1 month to 5 years, were subjected to detailed clinical history and examination.All patients received continuous monitoring of electrocardiograph ,pulse oximetry and respiratory rate .The patients were treated either with (HFNC) Humidified high flow nasal cannula or continuous positive airway pressure (CPAP). Studied groups were compared regarding demographic data, increasing in respiratory support ,need of intubation, fate and length of admission during PICU stay. Results HFNC was as efficient as CPAP in lowering RR(respiratory rate) and HR(heart rate) in infants with bronchiolitis and community acquired pneumonia. Thus HFNC group was as significant as NCPAP group in treatment of bronchiolitis and CAP regarding length of admission ,increasing of positive pressure and need of iintubation in PICU . Conclusion This study concluded that HFNC is as efficient as nCPAP for initial respiratory support in young infants, hospitalized in a PICU for moderate to severe acute respiratory failure.

THIRVE in Foreign Body Bronchus Removal-A Novel Approach.

We prospectively studied novel anesthetic and surgical approach to foreign body bronchus removal using HHFNC (heated humidified high flow nasal cannula)/THRIVE technique(Transnasal Humidified Rapid-Insufflation ventilatory Exchange) in eleven cases. MacIntosh Laryngoscope was used to expose laryngeal inlet and FB was removed with an optical forcep (mounted over 2.7mm rigid bronchoscope) without using ventilating bronchosocope. Total intravenous anaesthesia (TIVA) was given in all cases. FB was removed completely in all eleven cases. The average duration of procedure was 4.5min. HHFNC improved the apnoea time with 6min as maximum procedure time. Induction with Fentanyl, Intermittent Propofol injection and succinylcholine prevented excessive coughing, irritation, movement of the patient, vocal cords and posterior tracheal wall. Time management during this novel approach is crucial starting from removal of FB and check bronchoscopy.

Risk factors for treatment failure of heated humidified high-flow nasal cannula as initial respiratory support for preterm infants.

To study the risk factors for treatment failure of heated humidified high-flow nasal cannula (HHHFNC) as initial respiratory support for preterm infants. A retrospective analysis was performed on the medical data of the preterm infants who were admitted from January 2018 to April 2021 and received HHHFNC for initial respiratory support after birth. According to whether it was necessary to upgrade to noninvasive continuous positive airway pressure or invasive mechanical ventilation within 72 hours after treatment, they were divided into a failure group and a success group. Univariate and multivariate logistic regression analyses were used to determine the risk factors for failure of HHHFNC as initial respiratory support. A total of 166 preterm infants were included, among whom 48 (28.9%) experienced the treatment failure of HHHNFC as initial respiratory support. The univariate analysis showed that compared with the success group with 118 infants, the failure group had significantly lower gestational age and birth weight and a significantly higher proportion of infants with fraction of inspired oxygen >35%, flow rate >6 L/minute, patent ductus arteriosus (PDA), respiratory distress syndrome (RDS), or use of pulmonary surfactant (P<0.05). The multivariate logistic regression analysis showed that gestational age <32 weeks, PDA (>1.5 mm and left atrium/aorta diameter ratio >1.4), fraction of inspired oxygen >35%, flow rate >6 L/minute, and presence of RDS were risk factors for the treatment failure of HHHNFC as initial respiratory support (P<0.05). The preterm infants with a gestational age of <32 weeks or the presence of RDS tend to have a high risk of failure of HHHNFC as initial respiratory support. The risk of failure of HHHFNC as initial respiratory support increases in infants with oxygen concentration >35% and/or flow rate >6 L/minute, or the presence of PDA, suggesting an upgrade of respiratory support should be considered. Citation.

Comparison of four different non-invasive respiratory support techniques as primary respiratory support in preterm infants.

The use of non-invasive ventilation methods in neonatal intensive care units has been increasing in recent years. Non-invasive ventilation techniques are lung preserving methods and they reduce the risk of volutrauma, barotrauma, and atelectotrauma. The effect of heated humidified high-flow nasal cannula (HHHFNC), continuous positive airway pressure (CPAP), nasal intermittent positive-pressure ventilation (NIPPV), and nasal high-frequency oscillation ventilation (NHFOV) were compared in preterm infants with respiratory distress. Between December 2015 and February 2017, a total of 76 preterm infants (gestational age < 32 weeks) with respiratory distress were enrolled in this study. Of the patients, 20 received HHHFNC, while 20 received nasal CPAP (NCPAP), 19 received NIPPV, and 17 received NHFOV for respiratory support. The primary outcome was intubation requirement during non-invasive respiratory support. The secondary outcome included duration of non-invasive ventilation, air leak syndrome, abdominal distension, intraventricular hemorrhage, necrotizing enterocolitis (NEC), nasal injury, increased secretions, agitation, and mortality rate. The intubation ratio was higher in the NCPAP (40%) and NHFOV (29.4%) groups when compared with the NIPPV (10.5%) and HHHFNC (11.8%) groups. More nasal injury had developed in the NIPPV (78.9%) and NHFOV (82.4%) groups when compared with the NCPAP (40%) and HHHFNC (35%) groups. Moreover, the viscous secretion that blocked the cannulas was higher in NIPPV (78.9%) and NHFOV (76.5%) groups than NCPAP (25%) and HHHFNC (40%) groups. There were no significant differences in the duration of non-invasive ventilation methods, abdominal distension, NEC, air leak syndrome or mortality in the 4 groups. The NIPPV and HHHFNC methods can be useful as a primary mode of respiratory support for respiratory distress. However, doctors need to be careful with regard to the complications that may develop.

The safety and effectiveness of heated humidified high-flow nasal cannula as an initial ventilation method in the treatment of neonatal respiratory distress syndrome: A protocol for systematic review and meta-analysis.

Background:This study uses a method of systematic evaluation to evaluate the safety and effectiveness of heated humidified high-flow nasal cannula (HHHFNC) as an initial ventilation method in the treatment of neonatal respiratory distress syndrome (NRDS) scientifically. In the field of evidence-based medicine, this study provides a theoretical reference and basis for choosing appropriate initial non-invasive ventilation methods in the treatment of NRDS, thereby providing assistance for clinical treatment.Methods:The main electronic network databases were searched by computer, including 4 Chinese databases: CNKI, WangFang Data, CQVIP, SinoMed and 3 English databases: PubMed, The Cochrane Library and EMBASE, the time range of retrieval from the beginning of each database to September 1, 2020. The content involves all the published randomized controlled trials on the effectiveness of HHHFNC compared with NCPAP as an initial ventilation method in the treatment of NRDS. Using a search method that combines medical subject words and free words. Based on the Cochrane risk bias assessment tool, 2 researchers independently screen the literature, and then extract the data we needed in the literature, and cross-check. If it is difficult to decide whether to include literature, then turning to a third researcher for help and making a final decision after discussion, and using RevMan 5.3 and STATA 13.0 to analyze the relative data.Results:Based on the method of meta-analysis, this study analyzes the pre-determined outcome indicators through scientific statistical analysis, and compares the effectiveness and safety of HHHFNC compared with NCPAP as an initial ventilation method in the treatment of NRDS. All results will be published in peer-reviewed high-quality professional academic journals.Conclusion:Based on evidence-based medicine, this study will obtain the establishing evidence of comparison that the clinical effectiveness and safety of HHHFNC compared with NCPAP as an initial ventilation method in the treatment of NRDS through the existing data and data, which provides the evidence support of evidence-based medicine in the treatment of NRDS.OSF registration number:September 17, 2020. osf.io/f6at4 (https://osf.io/f6at4).

Heated Humidified High-Flow Nasal Cannula vs. Nasal Continuous Positive Airway Pressure for Post-extubation Respiratory Support in Preterm Infants: A Randomized Controlled Trial.

The objective of this study was to compare the efficacy and safety of heated humidified high-flow nasal cannula (HHHFNC) and nasal continuous positive airway pressure (nCPAP) for prevention of extubation failure in preterm infants. Preterm infants (gestation ≥28 weeks) were randomized to HHHFNC or nCPAP after extubation. Primary outcome was extubation failure within 72 h of extubation. A total of 128 preterm infants were randomized to receive either HHHFNC (n = 63) or nCPAP (n = 65) after extubation. The primary outcome of extubation failure within 72 h after extubation was not different between the two groups (HHHFNC, 22.2% vs. nCPAP, 18.5%, risk difference of 3.7% and 95% CI -10.3 to 17.6, p = 0.604). The incidence of nasal trauma was significantly lower in the HHHFNC group than in the nCPAP group 6.3% vs. 21.5%, p = 0.020. In our study, HHHFNC was as effective as nCPAP for prevention of extubation failure in preterm infants. Also, HHHFNC was associated with significantly less nasal trauma compared with nCPAP.

Heated humidified high flow nasal cannula versus nasal continuous positive airway pressure for respiratory support in extremely low birth weight preterm infants after extubation: a single centre randomized controlled trial

Background: The objective of the study was to assess the indications, frequency of usage, clinical efficacy, and safety of heated humidified high-flow nasal cannula (HHHFNC) and nasal continuous positive airway pressure (NCPAP) in extremely low birth weight preterm infants (ELBWI) after extubation.Methods: Hospital based prospective randomized control study involving ELBWI with respiratory distress admitted in NICU. In this study, all selected preterm infants were placed on one of the non-invasive respiratory supports (HHHFNC or NCPAP), after a period of positive pressure ventilation (post-extubation). Reintubation rate within 72 hours after initial extubation, duration of invasive ventilation, duration of non-invasive respiratory support, duration of supplemental oxygen, and time to reach full feeds were the primary outcome measures. Duration of total enteral feeding, average weight gain rate, duration of hospitalization, and complications including nasal injury, IVH, BPD, NEC, ROP, and PDA, were the secondary outcomes.Results: A sample size of 46 ELBWI were included. HHHFNC effectively reduced the incidence of nasal injury and NEC (p&lt;0.05) along with the decreased duration of supplementary oxygen. Additionally, HHHFNC achieved a significant advance in time to reach full enteral feeding; increased the average weight gain before discharge; reduced the duration of hospitalization (p&lt;0.05).Conclusions: HHHFNC was effective in preventing extubation failure in mechanically ventilated preterm ELBWI compared to NCPAP. HHHFNC shortens the duration of supplemental oxygen and significantly reduces the incidence of nasal injury and necrotizing enterocolitis; moreover, it can also reduce the duration of hospitalization and its cost.