High-flow nasal cannula and extubation success in the premature infant: a comparison of two modalities. Comparing two methods of delivering high-flow gas therapy by nasal cannula following endotracheal extubation: a prospective, randomized, masked, crossover trial. Nasal continuous positive airway pressure from high flow cannula versus Infant Flow for Preterm infants.
To compare the effectiveness of Fisher and Paykel (FP) and Vapotherm (VT) high-flow nasal cannula (HFNC) in preventing reintubation either within 72 h or <7 days after extubation of premature infants. The primary outcome was the rate of extubation failure defined as reintubation within 72 h. Secondary outcomes included reintubation after ≤7 days.
                This was a prospective, randomized pilot study comparing the extubation success of 40 infants born between 26 and 29 weeks of gestation.
                The rate of extubation failure at 72 h was 18% for FP and 9% for VT. The failure rate ≤7 days after extubation was 30% for FP and 27% for VT. None of these differences were statistically significant.
                There was no difference between FP and VT in the extubation success of infants born between 26 and 29 weeks. We compared two methods of delivering high-flow gas therapy by nasal cannula, applied immediately after planned endotracheal extubations of NICU patients.
                Thirty NICU patients who were about to be extubated from mechanical ventilation were randomized into two groups; Group 1 received Vapotherm for the first 24 h after extubation, then standard high-flow nasal cannula for the next 24 h, and Group 2 received standard high-flow therapy for the first 24 h, then Vapotherm for the next 24 h. At 24 h after extubation and again 48 h after extubation, a neonatologist who was not aware which modality the patient had been receiving examined the nasal mucosa and applied a scoring system. A research nurse who was unaware of the modality abstracted respiratory rates and respiratory effort scores from a specific study-bedside record. The experimental design was such that a patient could 'fail' extubation either by reintubation for mechanical ventilation, or by rescue to the opposite modality before completing the 24-h test period.
                Fifteen patients were randomized to Group 1 and 15 to Group 2. No differences were apparent between the groups in birth weight, gestational age, age at study entry, gender or underlying pulmonary disorder. Respiratory rates were similar while on Vapotherm (52+/-13 breaths/min, mean+/-s.d.) and high-flow (54+/-14/min). At 24 h after starting the modality, those on Vapotherm had more normal examinations of the nasal mucosa (2.7+/-1.2 vs 7.8+/-1.7, P < 0.0005) and lower respiratory effort scores (1.2+/-0.6 vs 2.0+/-0.9, P < 0.05) than did those on high-flow. No patients failed while on Vapotherm, but seven failed while on high-flow (two reintubations and five rescue switches to Vapotherm, P < 0.005).
                Among NICU patients immediately following extubation, Vapotherm performed better than a standard high-flow nasal cannula in maintaining a normal appearing nasal mucosa, a lower respiratory effort score, and averting reintubation. To compare the feasibility of continuous positive airway pressure (CPAP) support generated by high flow nasal cannula with conventional CPAP for prevention of reintubation among preterm infants with a birth weight of <or=1,250 g.
                Preterm infants were randomized to CPAP generated via high flow cannula or the Infant Flow Nasal CPAP System (VIASYS, Conshohocken, PA, USA) at extubation. Primary outcome was incidence of reintubation within 7 days. Secondary outcomes included change in oxygen use and frequency of apnea and bradycardias postextubation.
                Forty neonates were randomized. Twelve of 20 infants randomized to high flow cannula CPAP were reintubated compared to three of 20 using Infant Flow (P=0.003). The high flow cannula group had increased oxygen use and more apneas and bradycardias postextubation.
                CPAP delivered by high flow nasal cannula failed to maintain extubation status among preterm infants <or=1,250 g as effectively as Infant Flow CPAP.
There is insufficient evidence to establish the safety or effectiveness of HFNC as a form of respiratory support in preterm infants. When used following extubation, HFNC may be associated with a higher rate of reintubation than nasal CPAP. Further adequately powered randomised controlled trials should be undertaken in preterm infants comparing HFNC with nasal CPAP and with other means of respiratory support; or of support following extubation. These trials should measure clinically important outcomes.