NEW STUDY: CANNULAS WITH LONG NARROW TUBING SIGNIFICANTLY LESS COMMON NASAL TRAUMA

Cannulas with long, narrow tubing noninferior to short binasal prongs in preterm infants

November 30, 2020 

Use of cannulas with long and narrow tubing was noninferior to short binasal prongs and masks for providing nasal intermittent positive pressure ventilation in preterm infants, according to a study published in JAMA Pediatrics.

There was significantly less nasal trauma with use of the cannulas with long and narrow tubing, researchers reported.

“There is concern that this long, thin interface delivers reduced and suboptimal pressure transmission, tidal volume and support compared with short binasal prongs and masks, especially when leak at the nose is more than minimal,” Ori Hochwald, MD,senior physician in the neonatal ICU at Rambam Medical Center in Haifa, Israel, and colleagues wrote. “Despite its widespread use, the clinical efficacy of cannulas with long and narrow tubing was not thoroughly studied.”

The randomized, controlled, unblinded, prospective, noninferiority trial included 166 preterm infants born between 24 and 33 weeks and 6 days’ gestation who presented with respiratory distress syndrome requiring noninvasive ventilatory support as initial treatment after birth or following first extubation. Preterm infants were recruited from two tertiary neonatal ICUs from December 2017 to December 2019.

The primary outcome was intubation requirement within 72 hours after nasal intermittent positive pressure ventilation treatment began. Researchers defined the noninferiority margin as 15% or less absolute difference.

Preterm infants were randomly assigned to use of cannulas with long and narrow tubing (n = 83) or short binasal prongs and masks (n = 83). In the cannula tubing group, mean gestational age was 29.3 weeks and mean birth weight was 1,237 g; in the short binasal prongs and masks group, it was 29.2 weeks and 1,254 g, respectively.

In the cannula tubing group, the primary endpoint was reached in 12 (14%) infants compared with 15 (18%) in the short binasal prongs and masks group (risk difference = –3.6%; 95% CI, –14.8 to 7.6; P = .53).

Moderate to severe nasal trauma caused by ventilation was significantly less common in the cannula tubing group in four infants compared with 17 infants in the short binasal prongs and masks group (P = .01). Researchers observed no differences in other adverse events during hospitalization.

The researchers reported no differences in other adverse events between the two groups.

“Further larger studies are needed to establish the noninferiority and possible advantage of performing initial nasal intermittent positive pressure ventilation with cannulas with long and narrow tubing in the group of infants with lower gestational age and more severe respiratory distress syndrome,” the researchers wrote.

Article found here.

CPAP AND HELIOX

Nasal CPAP With 'Heliox' Helps Spare Preemies From Ventilators

In preterm infants with respiratory distress syndrome, using heliox - 80% helium and 20% oxygen - with nasal CPAP (continuous positive airway pressure) reduces the need for mechanical ventilation, Italian researchers say.

Dr. Mariarosa Colnaghi from University of Milan and colleagues pointed out online today in Pediatrics that others have suggested heliox might improve the effectiveness of noninvasive ventilation in adults and children, but there's very little data on newborns.

They note that because helium is so much less dense than air, it can reduce turbulent flow in the airways and reduce the resistance to flow. As a result, less pressure is needed to move gases to the periphery of the lungs, and gas exchange in the distal airways is improved.

In a randomized pilot study in preterm infants with respiratory distress syndrome (RDS) receiving nasal CPAP treatment, the researchers compared heliox (BOC Medical, The Linde Group, Munich, Germany) to medical air.

In the intervention group, babies received heliox for 12 hours. Beyond that, anyone still requiring nasal CPAP was switched to medical air.

The risk of intubation for mechanical ventilation was significantly lower with heliox than with medical air (14.8% vs 45.8%; p=0.029), the authors reported. Also, the proportion of babies needing surfactant was significantly lower in the heliox group (11.1% vs 43.5%; p=0.021).

The mean total duration of nasal CPAP was 26 days in the heliox group and 33 days in the medical air control group (P=0.681). Complications of prematurity did not differ between the groups, and there were no reported side effects.The benefits of heliox on these primary outcomes persisted after adjusting for other treatment, gestational age, gender, and other covariates, according to the investigators.

This was a small, unblinded pilot study, the authors acknowledge. Now, they say, "Additional studies are needed to confirm our data and verify whether heliox therapy is able to reduce the incidence of complications of prematurity, such as bronchopulmonary dysplasia."