High flow nasal cannula for respiratory support in term infants (Review)

Journal article


Dopper, Alex, Steele, Michael, Bogossian, Fiona and Hough, Judith. (2023). High flow nasal cannula for respiratory support in term infants (Review). Cochrane Database of Systematic Reviews. 2023(8), p. Article CD011010. https://doi.org/10.1002/14651858.CD011010.pub2
AuthorsDopper, Alex, Steele, Michael, Bogossian, Fiona and Hough, Judith
Abstract

Background
Respiratory failure or respiratory distress in infants is the most common reason for non‐elective admission to hospitals and neonatal intensive care units. Non‐invasive methods of respiratory support have become the preferred mode of treating respiratory problems as they avoid some of the complications associated with intubation and mechanical ventilation. High flow nasal cannula (HFNC) therapy is increasingly being used as a method of non‐invasive respiratory support. However, the evidence pertaining to its use in term infants (defined as infants ≥ 37 weeks gestational age to the end of the neonatal period (up to one month postnatal age)) is limited and there is no consensus of opinion regarding the safety and efficacy HFNC in this population.

Objectives
To assess the safety and efficacy of high flow nasal cannula oxygen therapy for respiratory support in term infants when compared with other forms of non‐invasive respiratory support.

Search methods
We searched the following databases in December 2022: Cochrane CENTRAL; PubMed; Embase; CINAHL; LILACS; Web of Science; Scopus. We also searched the reference lists of retrieved studies and performed a supplementary search of Google Scholar.

Selection criteria
We included randomised controlled trials (RCTs) that investigated the use of high flow nasal cannula oxygen therapy in infants ≥ 37 weeks gestational age up to one month postnatal age (the end of the neonatal period).

Data collection and analysis
Two review authors independently assessed trial eligibility, performed data extraction, and assessed risk of bias in the included studies. Where studies were sufficiently similar, we performed a meta‐analysis using mean differences (MD) for continuous data and risk ratios (RR) for dichotomous data, with their respective 95% confidence intervals (CIs). For statistically significant RRs, we calculated the number needed to treat for an additional beneficial outcome (NNTB). We used the GRADE approach to evaluate the certainty of the evidence for clinically important outcomes.

Main results
We included eight studies (654 participants) in this review. Six of these studies (625 participants) contributed data to our primary analyses.

Four studies contributed to our comparison of high flow nasal cannula (HFNC) oxygen therapy versus continuous positive airway pressure (CPAP) for respiratory support in term infants. The outcome of death was reported in two studies (439 infants) but there were no events in either group. HFNC may have little to no effect on treatment failure, but the evidence is very uncertain (RR 0.98, 95% CI 0.47 to 2.04; 3 trials, 452 infants; very low‐certainty evidence). The outcome of chronic lung disease (need for supplemental oxygen at 28 days of life) was reported in one study (375 participants) but there were no events in either group. HFNC may have little to no effect on the duration of respiratory support (any form of non‐invasive respiratory support with or without supplemental oxygen), but the evidence is very uncertain (MD 0.17 days, 95% CI ‐0.28 to 0.61; 4 trials, 530 infants; very low‐certainty evidence). HFNC likely results in little to no difference in the length of stay at the intensive care unit (ICU) (MD 0.90 days, 95% CI ‐0.31 to 2.12; 3 trials, 452 infants; moderate‐certainty evidence). HFNC may reduce the incidence of nasal trauma (RR 0.16, 95% CI 0.04 to 0.66; 1 trial, 78 infants; very low‐certainty evidence) and abdominal overdistension (RR 0.22, 95% CI 0.07 to 0.71; 1 trial, 78 infants; very low‐certainty evidence), but the evidence is very uncertain.

Two studies contributed to our analysis of HFNC versus low flow nasal cannula oxygen therapy (LFNC) (supplemental oxygen up to a maximum flow rate of 2 L/min). The outcome of death was reported in both studies (95 infants) but there were no events in either group. The evidence suggests that HFNC may reduce treatment failure slightly (RR 0.44, 95% CI 0.21 to 0.92; 2 trials, 95 infants; low‐certainty evidence). Neither study reported results for the outcome of chronic lung disease (need for supplemental oxygen at 28 days of life). HFNC may have little to no effect on the duration of respiratory support (MD ‐0.07 days, 95% CI ‐0.83 to 0.69; 1 trial, 74 infants; very low‐certainty evidence), length of stay at the ICU (MD 0.49 days, 95% CI ‐0.83 to 1.81; 1 trial, 74 infants; very low‐certainty evidence), or hospital length of stay (MD ‐0.60 days, 95% CI ‐2.07 to 0.86; 2 trials, 95 infants; very low‐certainty evidence), but the evidence is very uncertain. Adverse events was an outcome reported in both studies (95 infants) but there were no events in either group.

The risk of bias across outcomes was generally low, although there were some concerns of bias. The certainty of evidence across outcomes ranged from moderate to very low, downgraded due to risk of bias, imprecision, indirectness, and inconsistency.

Authors' conclusions
When compared with CPAP, HFNC may result in little to no difference in treatment failure. HFNC may have little to no effect on the duration of respiratory support, but the evidence is very uncertain. HFNC likely results in little to no difference in the length of stay at the intensive care unit. HFNC may reduce the incidence of nasal trauma and abdominal overdistension, but the evidence is very uncertain.

When compared with LFNC, HFNC may reduce treatment failure slightly. HFNC may have little to no effect on the duration of respiratory support, length of stay at the ICU, or hospital length of stay, but the evidence is very uncertain.

There is insufficient evidence to enable the formulation of evidence‐based guidelines on the use of HFNC for respiratory support in term infants. Larger, methodologically robust trials are required to further evaluate the possible health benefits or harms of HFNC in this patient population.

Year2023
JournalCochrane Database of Systematic Reviews
Journal citation2023 (8), p. Article CD011010
PublisherJohn Wiley & Sons Ltd
ISSN1465-1858
Digital Object Identifier (DOI)https://doi.org/10.1002/14651858.CD011010.pub2
PubMed ID37542728
Scopus EID2-s2.0-85166598216
PubMed Central IDPMC10401649
Open accessOpen access
Page range1-60
Publisher's version
License
All rights reserved
File Access Level
Open
Output statusPublished
Publication dates
Online04 Aug 2023
Publication process dates
Deposited24 Nov 2023
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Hough, Judith Leigh, Bagley, Catherine and Koorts, Pieter J.. (2012). Talipes equinovarus (clubfoot). In In M. W. Davies, G. D. T. Inglis and L. A. Jardine & P. J. Koorts (Ed.). Antenatal consults : A guide for neonatologists and paediatricians pp. 281-284 Churchill Livingstone.
Reduction of post-surgical pericardial adhesions using a pig model
Alizzi, Ali M., Summers, Phillip, Boon, Virginia H., Tantiongco, John-Paul, Thompson, Teresa, Leslie, Belinda J., Williams, David, Steele, Michael Craig, Bidstrup, Benjamin P. and Diqer, Al-Mutazz A.. (2012). Reduction of post-surgical pericardial adhesions using a pig model. Heart, Lung and Circulation. 21(1), pp. 22 - 29. https://doi.org/10.1016/j.hlc.2011.10.002
Lung recruitment manoeuvres for reducing respiratory morbidity in mechanically ventilated neonates
Jauncey-Cooke, J, Bogossian, F, Hough, J., Schibler, A, Davies, M W., Grant, C A., Gibbons, K and East, C E.. (2012). Lung recruitment manoeuvres for reducing respiratory morbidity in mechanically ventilated neonates. Cochrane Database of Systematic Reviews. Art.No.: CD009969 (Issue 7). https://doi.org/10.1002/14651858.CD009969
Humidified high flow nasal cannulae : Current practice in Australasian nurseries, a survey
Hough, Judith, Shearman, Andrew, Jardine, Luke and Davies, Mark. (2012). Humidified high flow nasal cannulae : Current practice in Australasian nurseries, a survey. Journal of Paediatrics and Child Health. 48(2), pp. 106 - 113. https://doi.org/10.1111/j.1440-1754.2011.02070.x
A comparison of 16 weeks of continuous vs intermittent exercise training in chronic heart failure patients
Smart, Neil A. and Steele, Michael Craig. (2012). A comparison of 16 weeks of continuous vs intermittent exercise training in chronic heart failure patients. Congestive Heart Failure. 18(4), pp. 205 - 211. https://doi.org/10.1111/j.1751-7133.2011.00274.x
Prognostic value of semi-quantitative bacteruria counts in the diagnosis of group B streptococcus urinary tract infection: A 4-year retrospective study in adult patients
Tan, Chee K., Ulett, Kimberly B., Steele, Michael C., Benjamin, William H. and Ulett, Glen C.. (2012). Prognostic value of semi-quantitative bacteruria counts in the diagnosis of group B streptococcus urinary tract infection: A 4-year retrospective study in adult patients. BMC Infectious Diseases. 12(273), pp. 1 - 8. https://doi.org/10.1186/1471-2334-12-273
Using community surveillance data to differentiate between emerging and endemic amphibian diseases
Young, Sam, Skerratt, Lee F., Mendez, Diana, Speare, Rick, Berger, Lee and Steele, Michael Craig. (2012). Using community surveillance data to differentiate between emerging and endemic amphibian diseases. Diseases of Aquatic Organisms. 98(1), pp. 1 - 10. https://doi.org/10.3354/dao02416
The effect of physical training on systemic proinflammatory cytokine expression in heart failure patients: A systematic review
Smart, Neil A. and Steele, Michael Craig. (2011). The effect of physical training on systemic proinflammatory cytokine expression in heart failure patients: A systematic review. Congestive Heart Failure. 17(3), pp. 110 - 114. https://doi.org/10.1111/j.1751-7133.2011.00217.x
The immediate effect of unilateral lumbar Z-joint mobilisation on posterior chain neurodynamics :A randomised controlled study
Szlezak, Adam, Georgilopoulos, Peter, Bullock-Saxton, Joanne and Steele, Michael. (2011). The immediate effect of unilateral lumbar Z-joint mobilisation on posterior chain neurodynamics :A randomised controlled study. Manual Therapy. 16, pp. 609 - 613. https://doi.org/10.1016/j.math.2011.06.004
Reduced intubation rates for infants after introduction of high-flow nasal prong oxygen delivery
Schibler, Andreas, Pham, Trang, Dunster, Kimble, Foster, Kim, Barlow, A, Gibbons, Kristen and Hough, Judith. (2011). Reduced intubation rates for infants after introduction of high-flow nasal prong oxygen delivery. Intensive Care Medicine. 37(5), pp. 847 - 852. https://doi.org/10.1007/s00134-011-2177-5
The impact of a temporary medical ward closure on emergency department and hospital service delivery outcomes
Crilly, Julia, Keijzers, Gerben B., Krahn, Dirken, Steele, Michael Craig, Green, David and Freeman, Janeen. (2011). The impact of a temporary medical ward closure on emergency department and hospital service delivery outcomes. Quality Management in Health Care. 20(4), pp. 322 - 333. https://doi.org/10.1097/QMH.0b013e318231355a
Exercise training in haemodialysis patients: A systematic review and meta-analysis
Smart, Neil and Steele, Michael Craig. (2011). Exercise training in haemodialysis patients: A systematic review and meta-analysis. Nephrology. 16(7), pp. 626 - 632. https://doi.org/10.1111/j.1440-1797.2011.01471.x
Measurement of ventilation and cardiac related impedance changes with electrical impedance tomography
Grant, Caroline, Pham, Trang, Hough, Judith, Riedel, T, Stocker, C and Schibler, Andreas. (2011). Measurement of ventilation and cardiac related impedance changes with electrical impedance tomography. Critical Care. 15(1), pp. 1 - 9. https://doi.org/10.1186/cc9985
Tertiary survey performance in a regional trauma hospital without a dedicated trauma service
Keijzers, Gerben B., Campbell, Don, Hooper, Jeffrey, Bost, Nerolie, Crilly, Julia, Steele, Michael Craig, Eddington, Blake and Geeraedts, Leo M.G.. (2011). Tertiary survey performance in a regional trauma hospital without a dedicated trauma service. World Journal of Surgery. 35(10), pp. 2341 - 2347. https://doi.org/10.1007/s00268-011-1231-3
Evaluating the statistical power of goodness-of-fit tests for health and medicine survey data
Steele, M., Smart, N., Hurst, C. and Chaseling, J.. (2009). Evaluating the statistical power of goodness-of-fit tests for health and medicine survey data. In R.S. Anderssen, R.D. Braddock and L.T.H. Newham (Ed.). The 18th World IMACS Congress and MODSIM09 International Congress on Modelling and Simulation. United States of America: Modelling and Simulation Society of Australia and New Zealand and International Association for Mathematics and Computers in Simulation, July 2009. pp. 192 - 196