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Part II - High Flow Nasal Cannulae (HFNC) versus CPAP

13 September 2016

3-4 Sep 2016 @ Hilton Tokyo Odaiba
Hosted by Fisher & Paykel Healthcare

Part II

HFNC - a technique to provide a range of flows of heated, humidified oxygen and air to patients requiring respiratory support, delivered through nasal cannulae.

Nursing perspective – easier to set up & use, more comfortable for infants, causes less nasal trauma, parents prefer it & infants tolerate feeds better.

Parent’s perspective – baby satisfied, better contact & interaction, able to take part in care.

A summary of 10 neonatal HFNC RCTs, N=2312 babies.

1. All studies reached the same conclusion for HFNC in post-extubation support for infants > 28/52 gestation – similar failure rates between CPAP & HFNC. No adverse effects especially air leaks. Lesser nasal trauma with HFNC.

2. Only one study concluded HFNC for post-INSURE (intubate & surfactant & extubate) in infants 30-34/52 gestation, showed similar rates between CPAP & HFNC.

3. HNFC as primary therapy for mild RDS, CPAP & HFNC have similar failure rates.

4. HFNC as primary therapy for moderate-severe RDS, showed higher failure rates with HFNC. Intubation rates & non-invasive ventilation (NIV) were similar.

5. Two studies showed similar time off any NIV support in infants < 32/52 gestation between CPAP & HFNC.

6. Abrupt change to HFNC versus gradual taper or wean leads to shorter time on CPAP.

7. Moved from skepticism to cautious adopters of HFNC, for post-extubation support in > 28/62, initial therapy in > 28/52 with Fi02 < 0.3 & with CPAP back up.

8. Good for kangaroo care from week 1 and establishment of breastfeeding from 32/52.

9. Gaps in knowledge include role of HFNC in non-tertiary settings, is one version of HFNC better than others, can we safely use higher flow rates & is there a role for HFNC in babies < 28/52

Musa Mohd Nordin
Reporting from Tokyo
4 Sep 2016

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