High Flow Nasal Cannula Vs nCPAP

Shoemaker MT, Pierce MR, Yoder BA, et al. High flow nasal cannula versus nasal CPAP for neonatal respiratory disease: a retrospective study. J Perinatology (Feb 2007); 27, 85–91. Full Text | PDF

Objective: Our objective is to assess the frequency of usage, safety and clinical utility of humidified high flow nasal cannula (HHFNC) in two tertiary care hospitals and compare outcomes to a historical control group of premature infants who received nasal continuous positive airway pressure (NCPAP).

Study design: The first part of the study describes the increased HHFNC usage in two tertiary neonatal intensive care units. The second part compares outcomes of infants, born at less than 30 weeks gestation, who received either NCPAP or HHFNC as an early respiratory support mode.

Results: HHFNC usage increased (64%) after its introduction in infants of all gestational ages whereas the usage of NCPAP decreased from 19 to 4%. Ninety-five percent of infants born at less than 30 weeks gestation received HHFNC at some point during their hospital stay whereas only 12% received NCPAP. There were no differences in death or bronchopulmonary dysplasia (BPD), but ventilator-days per patient were decreased (19.4 to 9.9) following introduction of HHFNC. Comparing the cohort of infants who received either NCPAP or HHFNC as an early mode of respiratory support, there were no differences in deaths, ventilator-days, BPD, blood infections or other outcomes. More infants were intubated for failing early NCPAP compared to early HHFNC (40 to 18%).

Conclusions: HHFNC was well-tolerated by premature infants. Compared to infants managed with NCPAP, there were no apparent differences in adverse outcomes following the introduction of HHFNC. Additional research is needed to better define the utility and safety of HHFNC compared to NCPAP.

Comments: In this study, HHFNC was used at nasal cannula flows between 2.5 and 8 LPM using the Vapotherm™ device. Apparently this treatment was very well tolerated, and it has practically eliminated the use of nCPAP for premature infants in the study centers. The major finding of this study was a much higher failure rate from early nasal CPAP compared with early HHFNC in infants < 30 weeks gestation. Due to the retrospective study design, these results need to be taken with a grain of salt. Randomized controlled trials comparing HHFNC with nasal CPAP are despirately needed. There were no instances of pneumothorax while on HHFNC noted. I remain concerned about the safety of using these very high flows with nasal cannula in these tiny infants. Previous studies have found the transmitted esophageal pressures on HHFNC to be very high (see 2-022). Further studies of the safety of this practice are needed. ABK.

We have encountered nasal excoriations and epistaxis with the use of high flow nasal cannula.

UserName: Maria Andrea Alano, MD
Institution: Bronx Lebanon Hospital Center

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