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Type: Journal article
Title: High-flow nasal cannulae in very preterm infants after extubation
Author: Manley, B.
Owen, L.
Doyle, L.
Andersen, C.
Cartwright, D.
Pritchard, M.
Donath, S.
Davis, P.
Citation: New England Journal of Medicine, 2013; 369(15):1425-1433
Publisher: Massachusetts Medical Society
Issue Date: 2013
ISSN: 0028-4793
Statement of
Brett J. Manley, Louise S. Owen, Lex W. Doyle, Chad C. Andersen, David W. Cartwright, Margo A. Pritchard, Susan M. Donath, and Peter G. Davis
Abstract: BACKGROUND: The use of high-flow nasal cannulae is an increasingly popular alternative to nasal continuous positive airway pressure (CPAP) for noninvasive respiratory support of very preterm infants (gestational age, <32 weeks) after extubation. However, data on the efficacy or safety of such cannulae in this population are lacking. METHODS: In this multicenter, randomized, noninferiority trial, we assigned 303 very preterm infants to receive treatment with either high-flow nasal cannulae (5 to 6 liters per minute) or nasal CPAP (7 cm of water) after extubation. The primary outcome was treatment failure within 7 days. Noninferiority was determined by calculating the absolute difference in the risk of the primary outcome; the margin of noninferiority was 20 percentage points. Infants in whom treatment with high-flow nasal cannulae failed could be treated with nasal CPAP; infants in whom nasal CPAP failed were reintubated. RESULTS: The use of high-flow nasal cannulae was noninferior to the use of nasal CPAP, with treatment failure occurring in 52 of 152 infants (34.2%) in the nasal-cannulae group and in 39 of 151 infants (25.8%) in the CPAP group (risk difference, 8.4 percentage points; 95% confidence interval, -1.9 to 18.7). Almost half the infants in whom treatment with high-flow nasal cannulae failed were successfully treated with CPAP without reintubation. The incidence of nasal trauma was significantly lower in the nasal-cannulae group than in the CPAP group (P=0.01), but there were no significant differences in rates of serious adverse events or other complications. CONCLUSIONS: Although the result for the primary outcome was close to the margin of noninferiority, the efficacy of high-flow nasal cannulae was similar to that of CPAP as respiratory support for very preterm infants after extubation. (Funded by the National Health and Medical Research Council; Australian New Zealand Clinical Trials Network number, ACTRN12610000166077.).
Keywords: Humans
Treatment Failure
Oxygen Inhalation Therapy
Continuous Positive Airway Pressure
Gestational Age
Infant, Newborn
Infant, Premature
Airway Extubation
Rights: Copyright © 2013 Massachusetts Medical Society. All rights reserved.
DOI: 10.1056/NEJMoa1300071
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Appears in Collections:Aurora harvest 2
Paediatrics publications

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