Department of Neonatology, Surya Hospital, Mumbai, Maharashtra, India.
Division of Neonatology, The Children's Hospital of Philadelphia and The University of Pennsylvania, Philadelphia, Pennsylvania.
Am J Perinatol. 2022 Nov;39(15):1693-1701. doi: 10.1055/s-0041-1726122. Epub 2021 Mar 23.
The study aimed to compare the efficacy and safety of two different nasal high-flow rates for primary respiratory support in preterm neonates STUDY DESIGN: In this single-center, double-blinded randomized controlled trial, preterm neonates ≥28 weeks of gestation with respiratory distress from birth were randomized to treatment with either increased nasal flow therapy (8-10 L/min) or standard nasal flow therapy (5-7 L/min). The primary outcome of nasal high-flow therapy failure was a composite outcome defined as the need for higher respiratory support (continuous positive airway pressure [CPAP] or mechanical ventilation) or surfactant therapy.
A total of 212 neonates were enrolled. Nasal high-flow failure rate in the increased flow group was similar to the standard flow group (22 vs. 29%, relative risk = 0.81 [95% confidence interval: 0.57-1.15]). However, nasal flow rate escalation was significantly more common in the standard flow group (64 vs. 43%, = 0.004). None of the infants in the increased flow group developed air leak syndromes.
Higher nasal flow rate (8-10 L/min) when compared with lower nasal flow rate of 5 to 7 L/min did not reduce the need for higher respiratory support (CPAP/mechanical ventilation) or surfactant therapy in moderately and late preterm neonates. However, initial flow rates of 5 L/min were not optimal for most preterm infants receiving primary nasal flow therapy.
· Use of high nasal flows (8-10 L/min) did not reduce the need for higher respiratory support in moderately and late preterm infants.. · Nasal flow rate of 5 L/min was not optimal for most preterms with respiratory distress from birth.. · Careful patient selection and optimized flow settings could enhance nasal flow success in neonates..
本研究旨在比较两种不同的高鼻气流率在早产儿原发性呼吸支持中的疗效和安全性。
这是一项单中心、双盲随机对照试验，将有呼吸窘迫的≥28 周早产儿从出生时随机分为高鼻气流治疗（8-10L/min）组或标准鼻气流治疗（5-7L/min）组。高鼻气流治疗失败的主要结局是需要更高的呼吸支持（持续气道正压通气[CPAP]或机械通气）或表面活性剂治疗的复合结局。
共纳入 212 例新生儿。高鼻气流组的高鼻气流失败率与标准鼻气流组相似（22%比 29%，相对风险=0.81[95%置信区间：0.57-1.15]）。然而，标准鼻气流组的鼻气流升级率明显更高（64%比 43%，=0.004）。高鼻气流组无一例发生气漏综合征。
与 5-7L/min 的低鼻气流相比，较高的鼻气流率（8-10L/min）并未降低中晚期早产儿接受原发性鼻气流治疗时对更高呼吸支持（CPAP/机械通气）或表面活性剂治疗的需求。然而，5L/min 的初始气流率对于大多数接受原发性鼻气流治疗的早产儿来说并不是最佳选择。
·在中晚期早产儿中，使用高鼻气流（8-10L/min）并不能降低对更高呼吸支持的需求。·对于大多数有呼吸窘迫的早产儿来说，5L/min 的鼻气流率并不理想。·仔细的患者选择和优化的气流设置可以提高新生儿鼻气流治疗的成功率。
