Hi-VNI® Technology Shows Similar Efficacy to nCPAP as Post-Extubation Support in Neonates

The results of the prospective, randomized controlled trial were published by Collins and colleagues in May 2013 in The Journal of Pediatrics titled “A Randomized Controlled Trial to Compare Heated Humidified High-Flow Nasal Cannulae with Nasal Continuous Positive Airway Pressure Postextubation in Premature Infants”. The trial found that among premature infants extubated from mechanical ventilation, extubation failure rates were statistically similar for the two modalities with 34% of infants receiving nCPAP (22 of 65) and 22% of infants receiving Vapotherm® Hi-VNI Technology (15 of 67) failing postextubation therapy. Infants in the Hi-VNI Technology group had significantly lower nasal trauma scores (3.1 vs 11.8; p < 0.001), and 12 (20%) of the infants assigned to nCPAP were subsequently treated with Vapotherm Hi-VNI Technology because of nasal trauma.

Infants extubated to Hi-VNI Technology were started at 8 L/min using the Precision Flow® device. Rates of pneumothorax were comparable between the two therapies with 1 (2%) in the nCPAP group and 0 (0%) in the Vapotherm group developing a post extubation pneumothorax (p=0.92). Rates of BPD at 36 weeks gestation were also similar between treatment groups.

“…[Hi-VNI Technology] resulted in significantly less nasal trauma than NCPAP. Damage to nasal mucosa may be a cause of unexplained septicemia in the preterm population. Nosocomial sepsis places a significant burden on the infant and healthcare system. Each episode of nosocomial sepsis is estimated to cost $10,000 (Australian) and increase length of stay by 5.2 days.”

The study suggests that Vapotherm Hi-VNI Technology is a viable alternative to nCPAP to support premature infants post-extubation while reducing the incidence rate and severity scores of nasal trauma. These findings are consistent with findings from other studies of Hi-VNI Technology in neonates.[1,2,3,4]

It should be noted that, like in most studies, the authors referred to Hi-VNI Technology as High Flow Nasal Cannula (HFNC). Hi-VNI Technology is only recently beginning to be recognized as a separate technology that is Mask-Free NIV for spontaneously breathing patients.[5]

[1] Collins CL, Holberton JR, Barfield C, Davis PG (2013) A randomized controlled trial to compare heated humidified high-flow nasal cannulae with nasal continuous positive airway pressure postextubation in premature infants. J Pediatr 162(5): 949-954 e941.
[2] Yoder BA, Stoddard RA, Li M, King J, Dirnberger DR, et al. (2013) Heated, humidified high-flow nasal cannula versus nasal CPAP for respiratory support in neonates. Pediatrics 131(5): e1482-1490.
[3] Kugelman A, Riskin A, Said W, Shoris I, Mor F, et al. (2015) A randomized pilot study comparing heated humidified high-flow nasal cannulae with NIPPV for RDS. Pediatr Pulmonol 50(6): 576-583.
[4] Lavizzari A, Colnaghi M, Ciuffini F, Veneroni C, Musumeci S, et al. (2016) Heated, Humidified High-Flow Nasal Cannula vs Nasal Continuous Positive Airway Pressure for Respiratory Distress Syndrome of Prematurity: A Randomized Clinical Noninferiority Trial. JAMA Pediatr.
[5] Doshi, Pratik et al. High-Velocity Nasal Insufflation in the Treatment of Respiratory Failure: A Randomized Clinical Trial. Annals of Emergency Medicine, 2018. Published online ahead of print. https://www.ncbi.nlm.nih.gov/pubmed/29310868