Primary Mode Of Respiratory Support Research Articles

Surfactant Therapy in Respiratory Distress Syndrome

Respiratory distress syndrome (RDS) is the leading cause of neonatal respiratory morbidity and mortality. Advancements in neonatal care, along with extended insurance coverage, have resulted in increased utilization of surfactant replacement therapy (SRT) for RDS. This has contributed to a decrease in neonatal mortality. The primary mode of respiratory support in infants with RDS has dramatically changed over the last decades, transitioning from invasive to noninvasive support. Therefore, less invasive surfactant therapy has emerged as a widely adopted approach for SRT, establishing itself as a standard method in preterm infants’ care. This review addresses pulmonary surfactant, from its discovery to application in newborns with RDS. It also reviews the history of guidelines of SRT and health insurance issues. Future studies should evaluate various emerging noninvasive respiratory support modalities along with SRT for the respiratory management of neonates, given the lack of sufficient evidence regarding these approaches.

Outcomes of patients aged ≥80 years with respiratory failure initially treated with non-invasive ventilation in European intensive care units before and during COVID-19 pandemic

BackgroundNon-invasive ventilation (NIV) has been commonly used to treat acute respiratory failure due to COVID-19. In this study we aimed to compare outcomes of older critically ill patients treated with NIV before and during the COVID-19 pandemic.MethodsWe analysed a merged cohort of older adults admitted to intensive care units (ICUs) due to respiratory failure. Patients were enrolled into one of two prospective observational studies: before COVID-19 (VIP2—2018 to 2019) and admitted due to COVID-19 (COVIP—March 2020 to January 2023). The outcomes included: 30-day mortality, intubation rate and NIV failure (death or intubation within 30 days).ResultsThe final cohort included 1986 patients (1292 from VIP2, 694 from COVIP) with a median age of 83 years. NIV was used as a primary mode of respiratory support in 697 participants (35.1%). ICU admission due to COVID-19 was associated with an increased 30-day mortality (65.5% vs. 36.5%, HR 2.18, 95% CI 1.71 to 2.77), more frequent intubation (36.9% vs. 17.5%, OR 2.63, 95% CI 1.74 to 3.99) and NIV failure (76.2% vs. 45.3%, OR 4.21, 95% CI 2.84 to 6.34) compared to non-COVID causes of respiratory failure. Sensitivity analysis after exclusion of patients in whom life supporting treatment limitation was introduced during primary NIV confirmed higher 30-day mortality in patients with COVID-19 (52.5% vs. 23.4%, HR 2.64, 95% CI 1.83 to 3.80).ConclusionThe outcomes of patients aged ≥80 years treated with NIV during COVID-19 pandemic were worse compared then those treated with NIV in the pre-pandemic era.

Comparison of Bubble CPAP Versus Conventional Ventilation in Neonates Having Respiratory Distress

Objective: To compare the outcomes of bubble continuous positive airway pressure (B-CPAP) versus ventilator continuous positive airway pressure (V-CPAP) in neonates experiencing respiratory distress. Methodology: This randomized controlled trial was conducted at the Department of Neonatology, Children's Hospital, Pakistan Institute of Medical Sciences (PIMS), Islamabad, from March 1, 2021, to August 31, 2021. A total of 150 neonates of both genders who presented with respiratory distress and were delivered at >32 weeks of gestation, weighing >1500 grams. The neonates were then randomly allocated to two groups using a lottery method. Treatment failure was defined as a neonate's inability to maintain a SpO2 greater than 90% or an arterial partial pressure (PaO2) greater than 50 mmHg with a maximal CPAP of >7 cm of water and a FiO2 greater than 0.6 or the necessity of mechanical ventilation. Results: Of these, 82 (54.7%) were male, and 68 (45.3%) were female, resulting in a male-to-female ratio of 1.2:1. The mean gestational age was 36±2.49 weeks in the B-CPAP group and 35.52±1.36 weeks in the V-CPAP group. The mean birth weight was 2381±506.4 grams in the B-CPAP group and 2187.3±427.49 grams in the V-CPAP group. Out of the 75 neonates in the B-CPAP group, 10 (13.3%) were classified as treatment failures, while 19 (25.3%) out of 75 neonates in the V-CPAP group met the criteria for treatment failure, according to our operational definition. Although the failure rate was slightly higher in patients receiving V-CPAP for the management of respiratory distress, these differences were not statistically significant (p-value= 0.052). Conclusion: In the treatment of neonatal respiratory distress, there was no significant difference in the failure rate between bubble CPAP and ventilatory CPAP. Regardless of the neonate's gender, birth weight, gestational age, or Silverman score, bubble CPAP may be considered as the primary mode of respiratory support for neonates with respiratory distress.

Surfactant administration in preterm babies (28-36 weeks) with respiratory distress syndrome: LISA versus InSurE, an open-label randomized controlled trial.

INtubate-SURfactant-Extubate (InSurE) approach is traditional method of surfactant delivery in preterm neonates with respiratory distress syndrome (RDS).Newer, less invasive surfactant administration (LISA) techniques lessen the need for mechanical ventilation and its adverse consequences. Evidence on the favorable effects of LISA can't be extrapolated from developed to developing countries. Aim of study is to compare the effectiveness of InSurE and LISA. Primary outcome was to find need of intubation and mechanical ventilation within 72 h of birth. Neonates were followed until discharge/death for adverse events and complications. MATERIALS ANDMETHODS: Open-label randomized controlled trial(RCT) was conducted at tertiary neonatal intensive care unit. Preterm neonates with diagnosis of RDS were randomized in two groups (InSurE or LISA) to receive surfactant soon after birth. Nasal intermittent positive pressure ventilation (NIPPV) was used as primary mode of respiratory support. A total of 150 neonates were analyzed (75 in each group). Insignificant statistical difference was seen in the need for intubation and mechanical ventilation within 72 h of birth between the two groups (InSurE, 30 [40%] and LISA, 30 [40%], relative risk 1.0, 95% confidence interval 0.68-1.48). Twelve percent (n = 9, LISA group) and 14.6% (n = 11 InSurE group) had adverse events during the procedure. Also, we observed insignificant statistical difference in the rates of major complications or duration of respiratory support, hospital stay, and mortality. LISA and InSurE are equally effective for surfactant administration in the treatment of RDS, when NIPPV is the primary mode of respiratory support. More RCTs are required to compare the efficacy & long-term outcomes of LISA with InSurE.

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 & 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.

CPAP-induced airway hyper-reactivity in mice is modulated by hyaluronan synthase-3.

Background:Continuous positive airway pressure (CPAP) is a primary mode of respiratory support for preterm infants. Animal studies have shown long-term detrimental effects on lung/airway development, particularly airway (AW) hyper-reactivity, as an unfortunate consequence of neonatal CPAP. Since the hyaluronan (HA) synthesizing enzyme hyaluronan synthase-3 (HAS3) is involved in various adult pulmonary disorders, the present study used a neonatal mouse model to investigate the role of HAS3 in CPAP-induced AW hyper-reactivity.Methods:Male and female neonatal mice were fitted with a custom-made mask for delivery of daily CPAP 3 h/day for 7 days. At postnatal day 21 (two weeks after CPAP ended), airway (AW) hyper-reactivity and HAS3 expression were assessed with and without in vitro HAS3 siRNA treatment.Results:MRIs of 3-day-old mice confirmed that CPAP increased lung volume with incrementing inflation pressures. CPAP increased AW reactivity in both male and female mice, which was associated with increased airway smooth muscle and epithelial HAS3 immunoreactivity. CPAP did not affect HA accumulation, but HAS3 siRNA reversed CPAP-induced AW hyper-reactivity and reduced HAS3 expression.Conclusions:These data in mice implicate a role for HAS3 in long-term effects of CPAP in the developing airway in the context of preterm birth and CPAP therapy.

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.

What Helps Us Decide to Adopt an Intervention: Efficacy, Costs, or Both?

What Helps Us Decide to Adopt an Intervention: Efficacy, Costs, or Both?

Synopsis on Non-invasive Ventilation in Neonatology

Non-invasive ventilation (NIV) is a mode of respiratory support commonly used on the neonatal unit. Since the advent of NIV, it has evolved from being used as a mode of respiratory support to wean infants from mechanical ventilation (MV) to a primary mode of respiratory support. NIV improve the functional residual capacity in the newborn (at term or preterm) avoiding invasive actions such as tracheal intubation. Newer methods of NIV support such as nasal bilevel positive airway pressure (BiPAP) and humidified high flow nasal cannula oxygen therapy (HHFNC) have emerged in attempts to reduce intubation rates and subsequent MV in preterm infants. With this synopsis, we aim to discuss various available NIV modes of ventilation in Neonatology, including indications, physiological principle, practical aspects and effects on important short and long-term morbidities associated with the use of NIV.

Bubble CPAP (Continuous Positive airway pressure) therapy as a primary mode of respiratory support in preterm newborns with mild to moderate respiratory distress syndrome

Background: Respiratory distress syndrome (RDS) is an important cause of morbidity and mortalityin preterm infants. Bubble CPAP when used appropriately, is more cost-effective, non-invasive,requires less training and has a lower risk of complications. However, not all preterm infants withRDS respond to CPAP. Aims: To study the immediate outcome of preterm infants with mild tomoderate respiratory distress syndrome on Bubble CPAP. To study the safety and effectiveness of B-CPAP and to identify the risk factors associated with its failure. Setting: NICU, Department ofpediatrics, Mamata general hospital and medical college, Khammam. Design- Prospectiveobservational study Material and Methods: This duration bound study was conducted fromFebruary 2018 to February 2020. Based on the inclusion criteria 73 Preterm babies with mild tomoderate respiratory distress syndrome requiring respiratory support were included in this study.Details of birth history, use of antenatal steroids, gestational age, type of delivery, birth weight,Downes score and chest X-ray were recorded. And the effectiveness and outcome of bubble CPAPwere studied. Results: Out of the total of 73 cases, 53(72.60%) were treated successfully, while20(27.40%) failed bubble CPAP. Conclusion: Bubble CPAP is the safe primary mode of respiratorysupport in Preterm newborns with mild to moderate RDS, more effective with early Initiation and inPreterm babies born to mothers with the use of antenatal steroids.

Nasal High-Frequency Oscillatory Ventilation in Preterm Infants with Moderate Respiratory Distress Syndrome: A Multicenter Randomized Clinical Trial

Objective: To determine whether nasal high-frequency oscillatory ventilation (NHFOV) as a primary mode of respiratory support as compared with nasal continuous airway pressure (NCPAP) will reduce the need for invasive mechanical ventilation in preterm infants (26^0/7–33^6/7 weeks of gestational age [GA]) with respiratory distress syndrome (RDS). Methods: This multicenter randomized controlled trial was conducted in 18 tertiary neonatal intensive care units in China. A total of 302 preterm infants born at a GA of 26^0/7–33^6/7 weeks with a diagnosis of RDS were randomly assigned to either the NCPAP (n = 150) or the NHFOV (n = 152) group. The primary outcome was the need for invasive mechanical ventilation during the first 7 days after birth. Results: Treatment failure occurred in 15 of 152 infants (9.9%) in the ­NHFOV group and in 26 of 150 infants (17.3%) in the NCPAP group (95% CI of risk difference: −15.2 to 0.4, p = 0.06). In the subgroup analysis, NHFOV resulted in a significantly lower rate of treatment failure than did NCPAP in the strata of 26^+0/7–29^+6/7weeks of GA (11.9 vs. 32.4%, 95% CI of risk difference: −39.3 to −1.7, p = 0.03) and birth weight <1,500 g (10.4 vs. 29.6%, 95% CI of risk difference: −33.8 to −4.6, p = 0.01). The rate of thick secretions causing an airway obstruction was higher in the NHFOV group than in the NCPAP group (13.8 vs. 5.3%, 95% CI of risk difference: 1.9–15.1, p = 0.01). No significant differences in other secondary outcomes were found between the NHFOV and NCPAP groups. Conclusions: NHFOV was not superior to NCPAP with regard to the primary outcome when applied as the primary respiratory support for RDS in infants between 26^+0/7 and 33^+6/7 weeks of GA. In the subgroup analysis, NHFOV seemed to improve effectiveness than NCPAP in preterm infants <30 weeks of GA.

Should High Flow Nasal Cannula Therapy Be the Primary Mode of Respiratory Support in a Pediatric Intensive Care Unit? Questions Remain!

Should High Flow Nasal Cannula Therapy Be the Primary Mode of Respiratory Support in a Pediatric Intensive Care Unit? Questions Remain!

Guidelines for surfactant replacement therapy in neonates.

Surfactant replacement therapy (SRT) plays a pivotal role in the management of neonates with respiratory distress syndrome (RDS) because it improves survival and reduces respiratory morbidities. With the increasing use of noninvasive ventilation as the primary mode of respiratory support for preterm infants at delivery, prophylactic surfactant is no longer beneficial. For infants with worsening RDS, early rescue surfactant should be provided. While the strategy to intubate, give surfactant, and extubate (INSURE) has been widely accepted in clinical practice, newer methods of noninvasive surfactant administration, using thin catheter, laryngeal mask airway, or nebulization, are being adopted or investigated. Use of SRT as an adjunct for conditions other than RDS, such as meconium aspiration syndrome, may be effective based on limited evidence.

Outcome of Neonatal Respiratory support Modalities in Sohag University Hospital

Background: Preterm neonates are at high risk of developing respiratory distress in the immediate post-natal period. Traditionally, these infants are managed by intubation and mechanical ventilation. The use of continuous positive airway pressure (CPAP) has gained immense popularity as a primary mode of respiratory support in these infants. Objective: To analyze indications of respiratory support, complications associated with each modality of respiratory support and short-term outcome. Patients and methods: This study included 100 neonates admitted to NICU, Pediatrics Department, Faculty of Medicine, Sohag University Hospital during one-year period. Their age ranged from 0-28 days with symptoms of respiratory distress, which were evident shortly after birth and requiring respiratory support. Results: The most common causes of admission were respiratory distress syndrome (RDS) 50%, sepsis 38%, asphyxia 8% and pneumonia 4%. Seventy two percent of the studied patients underwent CPAP, 14% oxygen support by nasal cannula and 14% mechanical ventilation. 82% of patients put on CPAP had improved and the failure rate of CPAP therapy was 18%. Adverse effects had occurred in 6 patients (42%) as: pneumothorax, ventilation acquired pneumonia and pulmonary hemorrhage. Mortality rate in ventilated babies in this work was 42.9%. Overall mortality rate in our study was 7%. Conclusion: CPAP was the most widely used and safe modality of respiratory support.

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.

Nasal High Frequency Oscillatory Ventilation Versus Nasal Continuous Positive Airway Pressure in Preterm Infants Less than 34 Weeks Gestation: A Multicentre Randomized Clinical Trial

Background: Nasal high-frequency oscillatory ventilation (NHFOV) has been increasingly applied as a rescue respiratory support after failure of nasal continuous positive airway pressure (NCPAP) in preterm infants. However, the efficacy of NHFOV as the primary mode of respiratory support for preterm infants with respiratory distress syndrome (RDS) has not been proved. Methods: This multi-center randomized controlled trial was conducted in 18 tertiary neonatal intensive care units in China. A total of 302 preterm infants born at a gestational age of 260/7 to 336/7 weeks with a diagnosis of RDS was randomly assigned to either the NCPAP (n=150) or the NHFOV(n=152) group. The primary outcome was the need for invasive mechanical ventilation during the first 7 days after birth. Results: Treatment failure occurred in 15 of 152 infants (9.9%) in the NHFOV group and in 26 of 150 infants (17.3%) in the NCPAP group (P = 0.06). NHFOV resulted in a significantly lower rate of treatment failure than did NCPAP in the strata of 26+0/7 to 29+6 /7 weeks GA (11.9% vs 32.4%, P = 0.03) and BW<1500g (10.4% vs 29.6%, P = 0.01). Conclusions: NHFOV was not superior to NCPAP with regard to the primary outcome when applied as the primary respiratory support for RDS in infants between 26+0/7 and 33+6/7 weeks GA. In a secondary analysis, NHFOV seemed to improve effectiveness than NCPAP in preterm infants <30 weeks gestational age. Trial Registration: The trial was registered with ClinicalTrials.Gov(NCT03099694) Funding Statement: The trial was initiated and planned by the researchers and funded by Scientific Research Projects unit of Chongqing (Project- cstc2016shms-ztzx13001) Declaration of Interests: None of the authors have declared conflicts of interests to participate in this trial. Ethics Approval Statement: The trial was approved by the ethics committee of Daping Hospital and the Research Institute of Surgery of the Third Military Medical University and the institutional review boards of each of the participating centers.

High Flow Nasal Cannula Therapy as a Primary Mode of Respiratory Support in a Pediatric Intensive Care Unit

To assess efficacy and safety of High flow nasal cannula therapy (HFNC) as primary mode of treatment for children with respiratory distress. Consecutive patients (1 mo-16 years) with respiratory distress were assessed for respiratory clinical score, COMFORT score and saturation to FiO2 (SF) ratio. A total of 188 (91.7%) patients out of 205 responded to HFNC alone. The respiratory clinical score and COMFORT score were lower with higher SF ratio in these than 17 patients who required ventilation (P<0.001). Median (IQR) time to failure was 2 (1.75-24) hours. Air leak was seen in 2 (1%) patients. HFNC is an effective and safe primary mode of respiratory support in children with respiratory distress. Children who succeed on HFNC show a favorable clinical response within first few hours.

Effectiveness of bubble continuous positive airway pressure as a primary mode of respiratory support in preterm neonates with respiratory distress syndrome at district level tertiary care hospital

Background: Continuous positive airway pressure (CPAP) has become a useful modality in the management of respiratory distress in preterm babies. CPAP when applied to preterm infants with respiratory distress syndrome (RDS) is associated with benefits in terms of reduced respiratory failure and reduced mortality. Objectives: The objectives of the study were to evaluate the efficacy of bubble CPAP in preterm neonates with RDS requiring respiratory support and to study the risk factors associated with its failure. Materials and Methods: A prospective observational study was done on 243 preterm neonates (gestational age [GA] 28 to ?37 weeks) with a diagnosis of RDS admitted from January 2016 to November 2017. All the eligible preterm neonates were started on bubble CPAP with binasal prongs. Surfactant was administered when indicated. Results: A total of 243 preterm neonates were enrolled in this study with a mean GA of 32.40 weeks and birth weight of 1831.49 g. One hundred and fifty-one (62.1%) were male and 92 (37.9%) were female. The mean age of starting of CPAP was 13.44 h of life and antenatal steroid coverage was 3.2% only. Of the 243 neonates, 195 neonates were successfully weaned off CPAP. Among the 48 neonates who failed CPAP, 27 neonates were ventilated, of which 20 (74.1%) survived. The predictors of CPAP failure were GA &lt;32 weeks, birth weight &lt;1.5 kg, and delayed initiation of CPAP. Conclusion: The efficacy of CPAP in neonates with mild-to-moderate RDS in preterm neonates is very well demonstrated despite the low usage of antenatal steroids, surfactant, and delayed initiation of CPAP. Extreme preterm, very low birth weight neonates with severe RDS on chest X-ray are at risk of failure of CPAP.

Evaluation of high flow nasal cannula versus continuous positive airway pressure as a respiratory support for preterm infants in zagazig university hospitals

BackgroundNasal continuous positive airway pressure (NCPAP) and early surfactant are known to reduce the lung inflammation and injury associated with mechanical ventilation (MV) and decreases the incidence of bronchopulmonary dysplasia (BPD). Avoidance of intubation and the increased use of NCPAP has become the primary mode of therapy for respiratory problems in preterm neonates. HFNC has become increasingly popular as a support modality where NCPAP might traditionally have been used. patients and methods We conducted a clinical trial on 42 preterm infants with respiratory distress, who were randomly divided into two equal groups as follows: Group 1 included 21 preterm infants receiving high-flow nasal cannula as a respiratory support. Group 2 included 21 preterm infants who received administration of nasal continuous positive airway pressure. All the neonates included in the study were subjected to history taking, clinical examination, laboratory investigationsResults Our study showed statistically a significant difference between HFNC and nasal CPAP groups regarding age at starting respiratory support and non-significant differences regarding intrauterine growth restriction, steroids, FiO2, surfactant and age at receiving surfactant. There were no significant differences in outcome. Also, there were no significant differences bewteen HFNC and NCPAP groups regarding time to reach full feeding and duration of hospitalization. But, there was statistically a significant difference between HFNC and nasal CPAP regarding severe nasal trauma. ConclusionHFNC appears to have similar efficacy to NCPAP when applied as a primary mode of respiratory support to preterm infants between 30 and 34 weeks of gestation with respiratory distress

High Flow Nasal Cannula versus Nasal Continuous Positive Airway Pressure for Primary Respiratory Support in Preterm Infants: A Prospective Randomized Study

This study compares high flow nasal cannula (HFNC) with nasal continuous positive airway pressure (nCPAP) within the first hour of life as the primary respiratory support in neonates of ≤32 weeks of gestational age. This prospective, randomized study was conducted in infants with a gestational age of ≤32 weeks who had spontaneous respiration. HFNC or nCPAP was used as a first line respiratory support after admission to intensive care unit. Primary outcome was primary treatment failure. Secondary outcomes were duration of noninvasive respiratory support and oxygen treatment, maximum FiO2 level, length of hospital stay, intubation rate, rates of respiratory distress syndrome, pneumothorax, and bronchopulmonary dysplasia. Subgroup analysis was performed for infants ≤28 weeks of gestational age. We enrolled 107 infants, 53 in HFNC and 54 to nCPAP group. There was no difference in primary outcome between the two groups. There was no difference between the groups in aspect of secondary outcomes. HFNC and nCPAP have no significant differences as a primary mode of respiratory support in preterm infants, in the time to wean off the devices and oxygen support, respiratory distress syndrome and bronchopulmonary dysplasia incidence, hospitalization duration, and rates of complications of prematurity.