Heated Humidified High-Flow Nasal Cannula for Preterm Infants: An Updated Systematic Review and Meta-analysis

Fleeman, Nigel ORCID: 0000-0002-4637-9779, Dundar, Yenal, Shah, Prakesh S and Shaw, Ben NJ (2019) Heated Humidified High-Flow Nasal Cannula for Preterm Infants: An Updated Systematic Review and Meta-analysis. INTERNATIONAL JOURNAL OF TECHNOLOGY ASSESSMENT IN HEALTH CARE, 35 (4). pp. 298-306.

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Official URL: http://dx.doi.org/10.1017/s0266462319000424

Abstract

<h4>Background</h4>Heated humidified high-flow nasal cannula (HHHFNC) is gaining popularity as a mode of respiratory support. We updated a systematic review and meta-analyses examining the efficacy and safety of HHHFNC compared with standard treatments for preterm infants. The primary outcome was the need for reintubation for preterm infants following mechanical ventilation (post-extubation analysis) or need for intubation for preterm infants not previously intubated (analysis of primary respiratory support).<h4>Methods</h4>We searched PubMed, MEDLINE, Embase, and the Cochrane Library for randomized controlled trials (RCTs) of HHHFNC versus standard treatments. Meta-analysis was conducted using Review Manager 5.3.<h4>Results</h4>The post-extubation analysis included ten RCTs (n = 1,201), and the analysis of primary respiratory support included ten RCTs (n = 1,676). There were no statistically significant differences for outcomes measuring efficacy, including the primary outcome. There were statistically significant differences favoring HHHFNC versus nasal cannula positive airway pressure (NCPAP) for air leak (post-extubation, risk ratio [RR] 0.29, 95 percent confidence interval [CI] 0.11 to 0.76, I2 = 0) and nasal trauma (post-extubation: 0.35, 95 percent CI 0.27 to 0.46, I2 = 5 percent; primary respiratory support: RR 0.52, 95 percent CI 0.37 to 0.74; I2 = 27 percent). Studies, particularly those of primary respiratory support, included very few preterm infants with gestational age (GA) <28 weeks.<h4>Conclusions</h4>HHHFNC may offer an efficacious and safe alternative to NCPAP for some infants but evidence is lacking for preterm infants with GA ≤28 weeks.

Item Type:	Article
Uncontrolled Keywords:	Preterm, Heated-humidified high-flow nasal cannula, Systematic review, Meta-analysis
Depositing User:	Symplectic Admin
Date Deposited:	16 Apr 2020 13:22
Last Modified:	18 Jan 2023 23:54
DOI:	10.1017/S0266462319000424
Related URLs:	Author Publisher
URI:	https://livrepository.liverpool.ac.uk/id/eprint/3083331