A Comparison of Humidified High Flow Nasal Cannula with Bubble CPAP in Very Low Birth Weight Infants

Abstract

목적: 극소저체중출생아에서 발관 시 가습고유량비강캐뉼라와 경비지속기도양압의 효과에 대해 비교연구 하였다.

방법: 2009년 1월부터 2012년 12월까지 아주대학교병원 신생아집중치료실에 입원한 출생체중 1,500 g 미만 환아들을 의무기록을 중심으로 후향적 분석하였다.

결과: 가습고유량비강캐뉼라와 경비지속기도양압군 간에 (1) 제태연령, 출생체중, 발관 시 나이 등의 통계 값, (2) FiO2, PIP, (3) 발관실패율 및 발관 후 FiO2, (4) 비침습적 환기의 기간, 산소투여 기간, 기관지폐이형성증 발병률 에서 차이가 없었다.

결론: 가습고유량비강캐뉼라는 극소저체중출생아에서 침습적 기계환기로부터 발관하는 데 있어 경비지속기도양압만 큼 효과적이다.

Purpose: To compare the effect of humidified high flow nasal cannula (HHFNC) with that of nasal continuous positive airway pressure (NCPAP) as the mode of extubation in very low birth weight infants (VLBWI).

Methods: Medical records were retrospectively reviewed for 219 VLBWI who were admitted to the neonatal intensive care unit of Ajou University Hospital from January 2009 through December 2012; 87 were supported by noninvasive ventilation (NIV) after extubation (HHFNC n=47, NCPAP n=40). Extubation failure was defined as the need for reintubation within 1 week of extubation.

Results: (1) There were no significant differences between the groups in demographic data such as gestational age, birth weight, and age at extubation. (2) There were no significant differences in fraction of inspired oxygen (FiO2) (HHFNC 0.23±0.03 vs. NCPAP 0.23±0.03, P-value .937) and peak inspiratory pressure (HHFNC 11±6.6 cmH2O vs. NCPAP 10.3±3.4 cmH2O, P-value .559) before extubation. (3) The rate of extubation failure and FiO2 values after extubation were similar in the 2 groups (extubation failure, HHFNC 5/47 vs. NCPAP 5/40, P-value 1.000; FiO2, HHFNC 0.24±0.05 vs. NCPAP 0.25±0.04, P-value .399). (4) Among patients who received NIV after extubation once but did not receive further intubation, the duration of NIV or duration of oxygen supply were not significantly different between the groups (NIV, HHFNC 12.4±9.1 days vs. NCPAP 8.7±12.3 days, P-value .159, oxygen supply, HHFNC 49.0±40.3 days vs. NCPAP 50.9±41.3 days, P-value .844) or bronchopulmonary dysplasia rate (HHFNC 24.3% vs. NCPAP 34.4%, P-value .430).

Conclusion: HHFNC is as effective as NCPAP for weaning VLBWIs from invasive mechanical ventilation.