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https://hdl.handle.net/2440/90371
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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 1533-4406 |
Statement of Responsibility: | 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 Female Male Catheters Airway Extubation |
Rights: | Copyright © 2013 Massachusetts Medical Society. All rights reserved. |
DOI: | 10.1056/NEJMoa1300071 |
Grant ID: | http://purl.org/au-research/grants/nhmrc/606789 http://purl.org/au-research/grants/nhmrc/546519 |
Published version: | http://dx.doi.org/10.1056/nejmoa1300071 |
Appears in Collections: | Aurora harvest 2 Paediatrics publications |
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