High-flow nasal cannulae in very preterm infants after extubation

Journal article


Manley, Brett J., Owen, Louise S., Doyle, Lex, Anderson, Chad, Cartwright, David, Pritchard, Margo, Donath, Susan and Davis, Peter. (2013) High-flow nasal cannulae in very preterm infants after extubation. New England Journal of Medicine. 369(15), pp. 1425 - 1433. https://doi.org/10.1056/NEJMoa1300071
AuthorsManley, Brett J., Owen, Louise S., Doyle, Lex, Anderson, Chad, Cartwright, David, Pritchard, Margo, Donath, Susan and Davis, Peter
Abstract

Background: The use of high-flow nasal cannulae is an increasingly popular alternative to nasal continuous positive airway pressure (CPAP) for noninvasive respiratory support of very preterm infants (gestational age, < 32 weeks) after extubation. However, data on the efficacy or safety of such cannulae in this population are lacking. Methods: In this multicenter, randomized, noninferiority trial, we assigned 303 very preterm infants to receive treatment with either high-flow nasal cannulae (5 to 6 liters per minute) or nasal CPAP (7 cm of water) after extubation. The primary outcome was treatment failure within 7 days. Noninferiority was determined by calculating the absolute difference in the risk of the primary outcome; the margin of noninferiority was 20 percentage points. Infants in whom treatment with high-flow nasal cannulae failed could be treated with nasal CPAP; infants in whom nasal CPAP failed were reintubated. Results: The use of high-flow nasal cannulae was noninferior to the use of nasal CPAP, with treatment failure occurring in 52 of 152 infants (34.2%) in the nasal-cannulae group and in 39 of 151 infants (25.8%) in the CPAP group (risk difference, 8.4 percentage points; 95% confidence interval, −1.9 to 18.7). Almost half the infants in whom treatment with high-flow nasal cannulae failed were successfully treated with CPAP without reintubation. The incidence of nasal trauma was significantly lower in the nasal-cannulae group than in the CPAP group (P=0.01), but there were no significant differences in rates of serious adverse events or other complications. Conclusions: Although the result for the primary outcome was close to the margin of noninferiority, the efficacy of high-flow nasal cannulae was similar to that of CPAP as respiratory support for very preterm infants after extubation. (Funded by the National Health and Medical Research Council; Australian New Zealand Clinical Trials Network number, ACTRN12610000166077.)

Year2013
JournalNew England Journal of Medicine
Journal citation369 (15), pp. 1425 - 1433
ISSN0028-4793
Digital Object Identifier (DOI)https://doi.org/10.1056/NEJMoa1300071
Scopus EID2-s2.0-84885670591
Open accessOpen access
Page range1425 - 1433
Research GroupSchool of Nursing, Midwifery and Paramedicine
Publisher's version
Grant IDnhmrc/546519
nhmrc/606789
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