Extubating very preterm infants to nasal cannula

In a multicenter trial, infants less than 32 weeks gestation who were being extubated were randomly placed either on nasal CPAP (7 cm water) or on high-flow nasal cannula (5 – 6 liters per minute). The primary outcome was treatment failure within seven days of extubation, which occurred in 34% of the nasal cannula group and in 26% of the nasal CPAP group. The absolute risk difference was 8%, with a 95% confidence interval of -2 to 19%. Around half the infants who failed the nasal cannula treatment were successfully treated with CPAP, without reintubation. The incidence of nasal trauma was significantly lower in infants treated with the nasal cannulae. This was a non-inferiority trial in which it was pre-specified that the two groups would be considered equivalent if the absolute difference between them was 20% or less. Therefore the authors concluded that high-flow nasal cannula support is as efficacious as nasal CPAP in very preterm infants being extubated.

High flow nasal cannula in very preterm infants after extubation. Manley et al, 2013.