Wilkinson Dominic, Andersen Chad, O'Donnell Colm Pf, De Paoli Antonio G
Discipline of Obstetrics and Gynecology, Women's and Children's Hospital, University of Adelaide, 72 King William Road, North Adelaide, SA, Australia, 5006.
Cochrane Database Syst Rev. 2011 May 11(5):CD006405. doi: 10.1002/14651858.CD006405.pub2.
High flow nasal cannulae (HFNC) are small, thin, tapered cannulae used to deliver oxygen or blended oxygen and air at flow rates of > 1 L/min. HFNC can be used to provide high concentrations of oxygen and may deliver positive end-expiratory pressure.
To compare the safety and efficacy of HFNC with other forms of non-invasive respiratory support in preterm infants.
The strategy included searches of the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2010), MEDLINE, CINAHL, EMBASE and abstracts from conference proceedings.
Randomised or quasi-randomised trials comparing HFNC with other non-invasive forms of respiratory support in preterm infants immediately after birth or following extubation.
Data were extracted and analysed by the authors. Relative risk, risk difference and number needed to treat were calculated.
Four studies were identified for inclusion in the review. The studies differed in the interventions compared (nasal continuous positive airway pressure (CPAP), humidified HFNC, non-humidified HFNC), the flow rates provided and the indications for respiratory support. Meta-analysis and subgroup analysis were not possible. When used as primary respiratory support after birth, one trial found similar rates of treatment failure in infants treated with HFNC and nasal CPAP. Following extubation, one trial found that infants treated with HFNC had a significantly higher rate of reintubation than those treated with nasal CPAP. Another trial found similar rates of reintubation for humidified and non-humidified HFNC, and the fourth trial found no difference between two different models of equipment used to deliver humidified HFNC.
AUTHORS' CONCLUSIONS: 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.
高流量鼻导管（HFNC）是一种细小、呈锥形的导管，用于以大于1升/分钟的流速输送氧气或混合氧气与空气。HFNC可用于提供高浓度氧气，并可能产生呼气末正压。
比较HFNC与其他形式的无创呼吸支持对早产儿的安全性和有效性。
检索策略包括对Cochrane对照试验中心注册库（CENTRAL）（《Cochrane图书馆2010年版》）、MEDLINE、CINAHL、EMBASE以及会议论文摘要进行检索。
将出生后即刻或拔管后使用HFNC与其他无创呼吸支持形式进行比较的随机或半随机试验。
作者提取并分析数据。计算相对风险、风险差异和需治疗人数。
确定了四项研究纳入本综述。这些研究在比较的干预措施（鼻持续气道正压通气（CPAP）、湿化HFNC、非湿化HFNC）、提供的流速以及呼吸支持指征方面存在差异。无法进行荟萃分析和亚组分析。一项试验发现，出生后作为主要呼吸支持手段时，接受HFNC治疗的婴儿与接受鼻CPAP治疗的婴儿治疗失败率相似。拔管后，一项试验发现接受HFNC治疗的婴儿再次插管率显著高于接受鼻CPAP治疗的婴儿。另一项试验发现湿化和非湿化HFNC的再次插管率相似，第四项试验发现用于输送湿化HFNC的两种不同型号设备之间没有差异。
尚无足够证据确定HFNC作为早产儿呼吸支持形式的安全性或有效性。拔管后使用时，HFNC可能比鼻CPAP的再次插管率更高。应在早产儿中进行进一步的、有足够样本量的随机对照试验，比较HFNC与鼻CPAP以及其他呼吸支持手段；或比较拔管后的支持情况。这些试验应测量具有临床重要意义的结局。
