- February 16, 2021
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 (2) 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 (2.73 pounds); in the short binasal prongs and masks group, it was 29.2 weeks and 1,254 g (2.76 pounds), 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.
REFERENCE: Helio Pulmonology Critical Care; 30 NOV 2020