Nasal high-flow therapy to Optimise Stability during Intubation: the NOSI pilot trial

Area of Science:

• Neonatal Intensive Care
• Respiratory Medicine
• Clinical Trials

Background:

• Nasal high-flow (NHF) therapy is used in adult respiratory failure to reduce hypoxia during intubation.
• Its efficacy in neonatal intubation remains under investigation.
• Pilot studies are crucial for informing larger, definitive trials.

Purpose of the Study:

• To assess the feasibility of using NHF during neonatal intubation.
• To calculate the duration of peripheral oxygen saturation below 75% during intubation attempts.
• To gather data for designing a larger, powered clinical trial.

Main Methods:

• A double-blinded, randomized controlled pilot trial was conducted in a tertiary neonatal center.
• Infants undergoing oral intubation were randomly assigned to receive NHF (6 L/min, FiO2 1.0) or no NHF (control) during intubation.
• The primary outcome was the duration of SpO2 <75% until successful intubation, stratified by gestational age (<34 weeks vs. ≥34 weeks).

Main Results:

• Forty-three infants (50 intubation episodes) were enrolled.
• In infants <34 weeks gestation, median duration of SpO2 <75% was 29s (NHF) vs. 43s (control) (p=0.78).
• In infants ≥34 weeks gestation, median duration of SpO2 <75% was 0s (NHF) vs. 0s (control) (p=0.9).

Conclusions:

• Providing NHF during neonatal intubation attempts is feasible.
• No significant differences in hypoxemia duration were observed between the NHF and control groups in this pilot study.
• A larger, higher-powered study is warranted to detect potential differences in outcomes.