Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT 84158-1289, USA.
Pediatrics. 2013 May;131(5):e1482-90. doi: 10.1542/peds.2012-2742. Epub 2013 Apr 22.
Heated, humidified high-flow nasal cannula (HHHFNC) is commonly used as a noninvasive mode of respiratory support in the NICU. The safety and efficacy of HHHFNC have not been compared with other modes of noninvasive support in large randomized trials. The objective was to assess the efficacy and safety of HHHFNC compared with nasal continuous positive airway pressure (nCPAP) for noninvasive respiratory support in the NICU.
Randomized, controlled, unblinded noncrossover trial in 432 infants ranging from 28 to 42 weeks' gestational age with planned nCPAP support, as either primary therapy or postextubation. The primary outcome was defined as a need for intubation within 72 hours of applied noninvasive therapy.
There was no difference in early failure for HHHFNC (23/212 [10.8%]) versus nCPAP (18/220 [8.2%]; P = .344), subsequent need for any intubation (32/212 [15.1%] vs 25/220 [11.4%]; P = .252), or in any of several adverse outcomes analyzed, including air leak. HHHFNC infants remained on the study mode significantly longer than nCPAP infants (median: 4 vs 2 days, respectively; P < .01), but there were no differences between study groups for days on supplemental oxygen (median: 10 vs 8 days), bronchopulmonary dysplasia (20% vs 16%), or discharge from the hospital on oxygen (19% vs 18%).
Among infants ≥28 weeks' gestational age, HHHFNC appears to have similar efficacy and safety to nCPAP when applied immediately postextubation or early as initial noninvasive support for respiratory dysfunction.
加热、湿化高流量鼻导管（HHHFNC）常用于新生儿重症监护病房（NICU）的非侵入性呼吸支持模式。在大型随机试验中，尚未比较 HHHFNC 与其他非侵入性支持模式的安全性和疗效。本研究旨在评估 HHHFNC 与鼻塞持续气道正压通气（nCPAP）在 NICU 中作为非侵入性呼吸支持的疗效和安全性。
在 432 名胎龄 28 至 42 周、计划接受 nCPAP 支持的婴儿中进行了一项随机、对照、非盲、非交叉试验，这些婴儿需要 nCPAP 支持，作为一线治疗或拔管后治疗。主要结局定义为应用非侵入性治疗后 72 小时内需要插管。
HHHFNC 组（23/212 [10.8%]）与 nCPAP 组（18/220 [8.2%]；P =.344）早期治疗失败率无差异，随后需要任何插管的比例（32/212 [15.1%] vs 25/220 [11.4%]；P =.252），或分析的其他几种不良结局，包括气漏，两组间也无差异。HHHFNC 组婴儿使用研究模式的时间明显长于 nCPAP 组（中位数：4 天对 2 天；P <.01），但两组在补充吸氧天数（中位数：10 天对 8 天）、支气管肺发育不良（20%对 16%）或出院时吸氧（19%对 18%）方面无差异。
在胎龄≥28 周的婴儿中，HHHFNC 似乎与 nCPAP 一样有效且安全，可在拔管后立即应用或作为呼吸功能障碍的初始非侵入性支持。
