The Effectiveness of the Heated Humidified High Flow Nasal Cannula as a Noninvasive Respiratory Support for Preterm Infants for Prevention of Extubation Failure

Aims: To compare the efficacy and safety of the HHHFNC as a post extubation respiratory support of preterm infants who were initially required endotracheal intubation and conventional mechanical ventilator after birth at different flow rates (3 L/min and 6 L/min).

Study Design: A Randomized controlled trial.

Place and Duration of Study: Neonatal Intensive Care Unit, Pediatrics department, Tanta University Hospitals, over one-year period, from December 2018 to December 2019.

Methodology: 30 preterm, with gestational age (30-36) weeks and birth weight ≥ 1300 g, were randomized to receive HHHFNC at either flow rate 3 or 6 L\min to prevent postextubation failure. Primary outcomes: the incidence of treatment failure of the HHHFNC at flow 3 and 6 L/min, which will require n CPAP or NIMV, or will require reintubation after successful extubation within 72 h. Secondary outcomes: rate of deaths within 72 hours post extubation, the total duration of all types of oxygen support, total duration of hospitalization and incidence of neonatal morbidities such as nasal trauma, BPD, symptomatic PDA, IVH ≥ grade II, pneumothorax, pulmonary hemorrhage, ROP, apnea, sepsis and NEC ≥ stage II.

Results: The incidence of need for higher flow rate of HHHFNC (n =17, 56.6%) , the need for n CPAP or NIMV after failure of higher flow rate of HHHFNC (n =16, 53.3%), the need for intubation & MV (n =7, 23.3%), the incidence of nasal trauma (n =9, 30%), BPD (n =9, 30%) , IVH ≥ II (n =7, 23.3%) , NEC ≥ II (n =0), pneumothorax ( n =5, 16.6%) , pulmonary haemorrhage (n =3, 10%), death (n =3, 10%), median duration of hospitalization in days =22.5 (17-28), median duration of all oxygen support in days = 18 (15-21), so the failure rate was 17 out of 30 (56.6%).

Conclusion: HHHFNC use is noninferior to other forms of noninvasive respiratory support in preterm infants for prevention of extubation failure. There were better outcomes of HHHFNC with higher gestational age and birth weight in preterm infants at either flow rates 3 or 6 L/min.