High-flow nasal cannula versus nasal continuous positive airway pressure for respiratory support in preterm infants: a meta-analysis of randomized controlled trials

2019 ◽  
Vol 34 (2) ◽  
pp. 259-266 ◽  
Author(s):  
Hui Hong ◽  
Xiao-xia Li ◽  
Jing Li ◽  
Zhi-qun Zhang
Keyword(s):  
Continuous Positive Airway Pressure ◽  
Randomized Controlled Trials ◽  
Preterm Infants ◽  
Airway Pressure ◽  
Positive Airway Pressure ◽  
Meta Analysis ◽  
High Flow ◽  
Controlled Trials ◽  
High Flow Nasal Cannula ◽  
Randomized Controlled

Systematic review of high-flow nasal cannula versus continuous positive airway pressure for primary support in preterm infants

2021 ◽  
pp. fetalneonatal-2020-321094
Author(s):  
Shaam Bruet ◽  
Marine Butin ◽  
Frederic Dutheil
Keyword(s):  
Continuous Positive Airway Pressure ◽  
Treatment Failure ◽  
Preterm Infants ◽  
Airway Pressure ◽  
Positive Airway Pressure ◽  
Meta Analysis ◽  
High Flow ◽  
Respiratory Support ◽  
High Flow Nasal Cannula ◽  
Nasal Trauma

IntroductionWe conducted a meta-analysis of trials that compared efficacy and safety of high-flow nasal cannula (HFNC) with continuous positive airway pressure (CPAP) as primary respiratory support in preterm infants and a study of the impact of clinical relevant parameters.MethodsDatabases were searched for randomised controlled trials comparing HFNC with CPAP as primary respiratory support in preterm infants. Treatment failure was considered as primary outcome and adverse events as secondary outcomes. We calculated risk ratios (RRs) in intention-to-treat analysis and random-effects meta-analyses of risks were conducted.ResultsWe included 10 studies for a total of 1830 patients. Meta-analysis demonstrated an RR of treatment failure multiplied by 1.34 using HFNC compared with CPAP (RR=1.34, 95% CI 1.01 to 1.68, I2=16.2%). Secondary outcome meta-analysis showed no difference in intubation rates (RR=0.90, 95% CI 0.66 to 1.15) and a lower rate of nasal trauma using HFNC compared with CPAP (RR=0.48, 95% CI 0.31 to 0.65, I²=0.0%). Meta-regressions did not show any influence of gestational age and weight at birth, HFNC flow rate, type of CPAP generator or use of surfactant.ConclusionsDespite a higher risk of treatment failure, considering no difference in intubation rates and a lower rate of nasal trauma using HFNC compared with CPAP, we suggest that HFNC should be used as primary respiratory support in preterm infants.

scholarly journals Bi-Level Noninvasive Ventilation in Neonatal Respiratory Distress Syndrome. A Systematic Review and Meta-Analysis

Neonatology ◽  
2021 ◽  
Vol 118 (3) ◽  
pp. 264-273
Author(s):  
Anne Lee Solevåg ◽  
Po-Yin Cheung ◽  
Georg M. Schmölzer
Keyword(s):  
Systematic Review ◽  
Continuous Positive Airway Pressure ◽  
Respiratory Distress Syndrome ◽  
Premature Infants ◽  
Airway Pressure ◽  
Distress Syndrome ◽  
Positive Airway Pressure ◽  
Meta Analysis ◽  
Controlled Trials ◽  
Randomized Controlled

<b><i>Background:</i></b> Bi-level noninvasive ventilation (NIV) has been used in respiratory distress syndrome (RDS) as primary treatment, post-extubation, and to treat apnea. This review summarizes studies on bi-level NIV in premature infants with RDS. Nonsynchronized nasal intermittent positive pressure ventilation (nsNIPPV) and synchronized NIPPV (SNIPPV) use pressure settings ≥ those used during mechanical ventilation (MV), and biphasic continuous positive airway pressure (BiPAP) use two nasal continuous positive airway pressure (NCPAP) levels ≤4 cm H<sub>2</sub>O apart. <b><i>Methods:</i></b> A systematic review (Medline OVID and Pubmed) and meta-analysis of randomized controlled trials. Primary outcomes were bronchopulmonary dysplasia (BPD) and mortality. Secondary outcomes included NIV failure (intubation) and extubation failure (re-intubation). Data were pooled using a fixed-effects model to calculate the relative risk (RR) with 95% confidence interval (CI) between NIV modes (RevMan v 5.3, Copenhagen, Denmark). <b><i>Results:</i></b> Twenty-four randomized controlled trials that largely did not correct for mean airway pressure (MAP) and used outdated ventilators were included. Compared with NCPAP, both nsNIPPV and SNIPPV resulted in less re-intubation (RR 0.88 with 95% CI (0.80, 0.97) and RR 0.20 (0.10, 0.38), respectively) and BPD (RR 0.69 (0.49, 0.97) and RR 0.51 (0.29, 0.88), respectively). nsNIPPV also resulted in less intubation (RR 0.57 (0.45, 0.73) versus NCPAP, with no difference in mortality. One study showed less intubation in BiPAP versus NCPAP. <b><i>Conclusions:</i></b> Bi-level NIV versus NCPAP may reduce MV and BPD in premature infants with RDS. Studies comparing equivalent MAP utilizing currently available machines are needed.

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