A randomized pilot study comparing heated humidified high-flow nasal cannulae with NIPPV for RDS

To compare the requirement for endotracheal ventilation in preterm infants treated with heated, humidified high-flow nasal cannula (HHHFNC) with those treated with nasal intermittent positive pressure ventilation (NIPPV) for the primary treatment of respiratory distress syndrome (RDS).

Randomized, controlled, prospective, single-center pilot study. Infants (gestational age [GA] <35 weeks, birth weight [BW] >1,000 g) with RDS were randomly assigned to receive HHHFNC (38 infants) delivered by Vapotherm® device (Precision Flow™ or 2000 i, Vapotherm Inc., Stevensville, MD), at flows between 1.0 and 5.0 L/min, or NIPPV (38 infants) delivered by the SLE 2000 or 5000. Surfactant was administered as rescue therapy. Analysis was done by intention-to-treat.

Infant's characteristics ([mean ± SD] GA 31.8 ± 2.3 vs. 32.0 ± 2.3 weeks) and cardio-respiratory status at study entry (FiO2 0.25 ± 0.05 vs. 0.26 ± 0.07; SpO2 90 ± 6% vs. 87 ± 12; PCO2 54.4 ± 10.4 vs. 52.6 ± 8.0 mmHg) were comparable for the HHHFNC and NIPPV groups. There was no significant difference in the need for endotracheal ventilation (28.9% vs. 34.2%) between HHHFNC and NIPPV groups. One infant failed HHHFNC and succeeded on NIPPV. The rate of neonatal morbidities (pneumothorax, bronchopulmonary dysplasia, intra-ventricular hemorrhage, necrotizing enterocolitis, patent ductus arteriosus, and nasal trauma) was comparable in both groups. Duration of nasal support was longer with HHHFNC compared with NIPPV (5.4 ± 4.0 vs. 2.6 ± 1.9 days, P = 0.006) but the duration of endotracheal ventilation, time to full feeds, and length of stay were comparable.

Our pilot study suggests that HHHFNC maybe as effective as NIPPV in preventing endotracheal ventilation in the primary treatment of RDS in premature infants (<35 weeks GA and BW >1,000 g).