Versus Nasal Continuous Positive Airway Research Articles

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 Versus Nasal Continuous Positive Airway Pressure for Respiratory Support of Preterm Neonates

High Flow Nasal Cannula Versus Nasal Continuous Positive Airway Pressure for Respiratory Support of Preterm Neonates

Efficacy and Complications of Humidified High-Flow Nasal Cannula Versus Nasal Continuous Positive Airway Pressure in Neonates with Respiratory Distress Syndrome After Surfactant Therapy

Background: Neonatal respiratory distress syndrome (RDS) is a problem that often occurs in preterm neonates. Objectives: The present study was conducted to compare the efficacy and complications of humidified high flow nasal cannula (HFNC) with those of nasal continuous positive airway pressure (NCPAP) after surfactant therapy in neonates with RDS. Methods: This clinical trial was conducted on 60 neonates with the gestational age of 28 - 36 weeks suffering from RDS and admitted to Fatemieh Hospital in Hamadan, Iran, during 2017. Initially, all newborns were administered with exogenous surfactant. Subsequently, the participants were randomly assigned into two groups of HFNC (group 1) and NCPAP (group 2) to receive respiratory support. The NCPAP group was managed with a mask or nasal prong. The HFNC group was given warm and humid oxygen through a short binasal cannula proportional to the weight of each neonate until the recovery of respiratory distress. Results: The mean one-minute Apgar scores were obtained as 6.23 ± 1.55 and 6.60 ± 1.07 in the HFNC and NCPAP groups, respectively. Furthermore, the mean five-minute Apgar scores were 8.0 ± 1.11 and 8.17 ± 0.95 in these groups, respectively. The mothers and neonates in both groups were comparable in terms of demographic and clinical data, except for gestational age and neonatal gender (P = 0.05). Furthermore, there was no statistically significant difference between the HFNC and NCPAP groups regarding the respiratory outcomes (P = 0.05). Conclusions: As the findings indicated, humidified high flow nasal cannula was as effective as nasal continuous positive airway pressure in the management of respiratory distress in premature neonates with the gestational age of 28 - 36 weeks. Consequently, these two interventions could be used interchangeably for the provision of respiratory support among these patients.

Heated Humidified High-Flow Nasal Cannula Versus Nasal Continuous Positive Airway Pressure for the Facilitation of Extubation in Preterm Neonates with Respiratory Distress

Background: Heated humidified high-flow nasal cannula (HHHFNC) is gaining popularity as an alternative to nasal continuous positive airway pressure (nCPAP) therapy in the management of preterm neonates with respiratory distress due to ease of administration and patient comfort. However, limited evidence is available addressing its risks and benefits. To study the efficacy and safety of HHHFNC in comparison to nCPAP for the facilitation of extubation in preterm neonates (born at 27-34 weeks of gestation) with respiratory distress.Methods: A prospective observational study was conducted, where 64 neonates were assigned either to nCPAP (n=34) or HHHFNC (n=30) groups post-extubation. The primary outcome was treatment failure (defined by pre-specified criteria) requiring a higher modality of respiratory support within 72 hours after extubation.Results: Treatment failure was seen in 36.7% of neonates assigned to the HHHFNC group compared to 14.7% in the nCPAP group (P=0.043). The incidence and severity of nasal trauma were higher in the nCPAP group compared to the HHHFNC group (nCPAP: 58.6% vs. HHHFNC: 15.7%; P=0.001). No significant difference was observed between the two groups in terms of other outcomes such as days on primary non-invasive ventilation (NIV), days of total NIV, duration of hospitalization, days to reach full enteral feeding, weight gain at discharge, incidence and severity of nasal trauma, incidence of pneumothorax, necrotizing enterocolitis, intraventricular hemorrhage, retinopathy of prematurity, sepsis, and death.Conclusion: Though a gentler modality with less incidence of nasal trauma, HHHFNC does not appear to be as effective as nCPAP in the management of preterms with respiratory distress.

1780 Effect of Nasal Synchronized Intermittent Mandatory Ventilation Versus Nasal Continuous Positive Airway Pressure in Reducing Reintubation of Extubated Preterm Infants

BackgroundNasal flow-synchronized intermittent mandatory ventilation (NSIMV) is a new non-invasive ventilatory mode that delivers synchronized mechanical breaths through the nasal tube.This study was conducted to compare the efficacy of NSIMV...

393 High-Flow Nasal Cannula Versus Nasal Continuous Positive Airway Pressure in the Management of Respiratory Distress Syndrome

Background and AimsAlthough nasal continuous positive airway pressure (NCPAP) in the treatment of respiratory distress syndrome (RDS) is an effective and a non-invasive method, some complications such as septal trauma...

Comparing Humidified High Flow Nasal Cannula (HHFNC) Versus Nasal Continuous Positive Airway Pressure (NCPAP) as Respiratory Supports after Extubation in Preterm Infants

Background & Aim: After Vapotherm HHFNC was discontinued, the other type of HHFNC (RT329 Infant Oxygen Delivery System) was introduced but there are few studies using this system. The aim of this study is to evaluate the effectiveness and safety of HHFNC as a mode of respiratory support after extubation for preterm infants compared with nCPAP. Methods: This was a retrospective study of preterm infants supplied by HHFNC or nCPAP after extubation at Korea University Ansan Hospital. For short term effects, the change of heart rate, respiration rate and FiO2 needed for respiratory stabilization were monitored. The rates of re-intubation/weaning within 72 hours after extubation were measured. The complication (localized nasal necrosis, localized nasal infection and air leak syndrome) after use were recorded. Results: HHFNC group (n=23) and nCPAP group (n=23) had similar gestational age and birth weight. There were no significant differences of short term effects in both groups. The rate of re-intubation was 26% (6/23) in HHFNC group and 17% (4/23) in nCPAP group (P=0.78). The rate of weaning from the device was 39% (9/23) in HHFNC group and 48% (11/23) in nCPAP group (P=0.52). There were no statistically significant differences of complications in both groups. Conclusions: Comparing HHFNC with nCPAP, there were the similar rates of re-intubation/weaning and no differences in adverse outcomes. HHFNC may be an effective and safe as a mode of respiratory support after extubation in preterm infants. However, well-designed random trial control studies are needed for clinical application.

509 Nasal Intermittent Positive Pressure Ventilation Versus Nasal Continuous Positive Airway Pressure for Neonatal Respiratory Failure: A Prospective, Randomized, Controlled Study

Objective: To evaluate whether nasal intermittent positive pressure ventilation (NIPPV) compared with nasal continuous positive airway pressure (nCPAP) would decrease the requirement for endotracheal ventilation in the treatment of respiratory failure in preterm and term infants. Methods: Prospective, randomized, controlled, single-center study. 101 neonatal infants were randomized into NIPPV group (n=48) and nCPAP group (n=53) between January, 2008 and December, 2008 in a neonatal intensive care unit of a tertiary hospital. The ratio of requirement for endotracheal ventilation and the outcome were investigated. Results: Neonates treated with NIPPV and with nCPAP had comparable clinical conditions at study entry. Infants treated initially with NIPPV need less endotracheal ventilation than those treated with nCPAP (23% vs 38%, p< 0.05). However, there was no significant difference between NIPPV group and nCPAP group in the ratio of good outcome (94% vs 87%, p>0.05). Conclusion: NIPPV compared with nCPAP decreased the requirement for endotracheal ventilation in neonatal infants with respiratory failure.

Nasal Intermittent Mandatory Ventilation Versus Nasal Continuous Positive Airway Pressure for Respiratory Distress Syndrome: A Randomized, Controlled, Prospective Study

To evaluate whether nasal intermittent mandatory ventilation (NIMV) compared with nasal continuous positive airway pressure (NCPAP) would decrease the requirement for endotracheal ventilation in the treatment of respiratory distress syndrome (RDS) in preterm infants <35 weeks. Randomized, controlled, prospective, single-center study. Forty-one infants were randomized to NCPAP and 43 comparable infants to NIMV (birth weight 1533 +/- 603 vs 1616 +/- 494 g, gestational age 30.6 +/- 3.0 vs 31.1 +/- 2.3 weeks, P = .5, respectively). Infants treated with NIMV and with NCPAP had comparable cardio-respiratory status at study entry. In the total cohort, infants treated initially with NIMV needed less endotracheal ventilation than infants treated with NCPAP (25% vs 49%, P < .05) with a similar trend in infants <1500 g; 31% vs 62%, P =. 06). When controlling for weight and gestational age, NIMV was more successful in preventing endotracheal ventilation (P < .05). Infants treated with NIMV had a decreased incidence of bronchopulmonary dysplasia (BPD) compared with those treated with NCPAP (2% vs 17%, P <. 05, in the total cohort and 5% vs 33%, P <. 05, for infants <1500 g). NIMV compared with NCPAP decreased the requirement for endotracheal ventilation in premature infants with RDS. This was associated with a decreased incidence of BPD.

A Prospective Randomized Controlled Study Comparing Synchronized Nasal Intermittent Positive Pressure Ventilation (SNIPPV) Versus Nasal Continuous Positive Airway Pressure (NCPAP) as a Method of Weaning Infants with Respiratory Distress Syndrome (RDS) from the Ventilator

A Prospective Randomized Controlled Study Comparing Synchronized Nasal Intermittent Positive Pressure Ventilation (SNIPPV) Versus Nasal Continuous Positive Airway Pressure (NCPAP) as a Method of Weaning Infants with Respiratory Distress Syndrome (RDS) from the Ventilator