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Efficacy and Safety of Heated humidified high-flow nasal cannula for Preventing Extubation Failure in Neonates: A Systematic Review and Meta-Analysis


 Background: Heated humidified high-flow nasal cannula (HHHFNC) is gaining popularity as a mode of respiratory support. We updated a meta-analysis examining the efficacy and safety of HHHFNC compared with nasal continuous positive airway pressure (NCPAP) for infants. Methods: Literature searches were conducted using PubMed, Cochrane Library, OVID, Embase, Web of Science, Chinese Biomedical Literature, Weipu Journal, Wanfang, and CNKI databases up to December 2020. Only randomized controlled trials (RCTs) of HHHFNC versus NCPAP in preventing extubation failure for infants were included. Results: A total of 13 RCTs research literatures involving 2395 infants were included in the Meta-analysis. The meta-analysis showed the following results. (1) In terms of efficacy, there were no significant differences between two groups in the treatment failure rate (RR: 1.00, 95%CI: 0.73 to 1.36, P=0.99) and reintubation rate (RR: 0.86, 95%CI: 0.70 to 1.06, P=0.16). While in term of safety, HHHFNC had a significant advantage over NCPAP in reducing the incidence rates of nasal trauma (RR: 0.27, 95%CI: 0.13 to 0.56, P=0.0005) and frequent hemorrhoid (RR: 0.40, 95%CI: 0.23 to 0.70, P=0.001).(2) In terms of secondary outcome measures, there were no significant differences between two groups in hospital mortality rate and incidence rates of BPD, ROP, IVH and duration of reaching full enteral feeding(P>0.05). HHHFNC demonstrated lower incidence of NEC (RR: 0.65, 95%CI: 0.43 to 0.98, P=0.04) than NCPAP. Conclusion:this meta-analysis showed that HHHFNC appears to be similar to NCPAP in efficacy of preventing extubation failure in infants. It is associated with significantly lower odds of nasal trauma, frequent hemorrhoid and NEC.