April 7, 2022

Effect of High-Flow Nasal Cannula Therapy vs Continuous Positive Airway Pressure Following Extubation on Liberation from Respiratory Support in Critically Ill Children.

Summarized by: 

Mazen Kherallah

What was the research question?

In critically ill children who were assessed to be needing a non-invasive respiratory support within 72 hours post extubation (population), is the first-line use of HFNC at 2 L/kg/min (intervention) non inferior to CPAP at 7-8 cm H2O (comparator) in terms of time to liberation from all forms of respiratory support (outcome)?

How did they do it?

A pragmatic, open label, multi-center, parallel group, non-inferiority trial 22 pediatric intensive care units in the United Kingdom that randomized children of the study in a 1:1 ratio to receive HFNC versus CPAP.

What did they find?

553 children out of 600 were randomized to HFNC (281) or CPAP (272).  Median age was 3 months and 44% were girls. Median time to liberation was 50.5 hours for HFNC compared to 42.9 hours for CPAP (adjusted HR, 0.83; 1-sided 97.5% CI, 0.70-∞) indicating that HFNC failed the noninferiority testing in this trial. Mortality at day 180 as a secondary outcome measure was 5.6% in HFNC versus 2.4% in CPAP (adjusted odds ratio, 3.07 [95% CI, 1.1-8.8]). However, mortality at PICU discharge was not different and the number of the specimen is relatively low.

What does it mean?

The study failed to show a noninferiority of HFNC compared to CPAP. This study is likely to have a high impact on the choice of respiratory support after extubation in favor of CPAP in young children.