High-flow nasal cannulae (HFNC) in der Neonatologie: Umfrage über Einsatz und Erfahrungen in den nordrheinwestfälischen Level 1 Perinatalzentren

Zusammenfassung

Einleitung: High-flow nasal cannulae (HFNC) ist eine Form der nicht-invasiven Atemhilfe, die in den letzten Jahren immer häufiger bei neonatologischen Patienten mit Atemstörungen eingesetzt werden. Wir untersuchten landesweit persönliche Erfahrungen und Indikationsstellungen unter den Neonatologen der Level 1 Perinatalzentren Nordrhein-Westfalens.

Methode: Online Umfrage.

Ergebnisse: 93% der Befragten nutzen HFNC-Systeme in Ihren Perinatalzentren. Hauptindikationen sind CPAP-Weaning, nasale Traumen und das Apnoe-Bradykardie-Syndrom. Die Initialeinstellung, sowie Maximal- und Minimaleinstellung der Flowrate unterscheidet sich zwischen den Befragten zum Teil erheblich. Der Vorteil von HFNC-Sytemen gegenüber konventionellem CPAP wird in der besseren Patiententoleranz, bei zugleich weniger nasaler Traumen und einfacherem Handling gesehen. Den größten Nachteil sehen die Befragten in der fehlenden PEEP-Messung.

Diskussion: HFNC-Systeme werden in der Neonatologie bei bestimmten Indikationen zunehmend eingesetzt. Die Datenlage über Sicherheit und Effektivität wird in den letzten Jahren größer. Untersuchungen über die „richtige“ Flowrateneinstellung stehen noch aus.

Abstract

Introduction: High-flow nasal cannulae (HFNC) is a kind of non-invasive respiratory support. In recent years, its application has gained increasing popularity for treating neonates with respiratory failure. Within this study, neonatologists employed at high level perinatal centres within the region of North Rhine-Westphalia, Germany were interviewed. We evaluated their personal experience as well as the underlying indication for using HFNC.

Method: We undertook an online survey.

Results: 93% of the interviewed participants use HFNC systems in their NICU. The most prominent indications were CPAP-weaning, nasal trauma, and apnoea of prematurity. Both initial flow and maximum and minimum flow rates varied widely. The primary benefit of HFNC vs. conventional CPAP was the improved neonate tolerance, less nasal traumata and ease of application and care. A common disadvantage was the inability to conduct PEEP measurements.

Discussion: The application of the HFNC system is increasing for specific neonatal indications, thereby increasing the data for the evaluation of effectivity and safety. Nevertheless, detailed investigations of the appropriate flow rate settings are still lacking.

Schlüsselwörter

High-flow nasal cannulae - HFNC - CPAP - Atemhilfe - Frühgeborene

Key words

high-flow nasal cannulae - HFNC - CPAP - respiratory support - preterm infants

• Literatur

• 1 Lavizzari A, Veneroni C, Colnaghi M et al. Respiratory mechanics during NCPAP and HHHFNC at equal distending pressures. Arch Dis Child Fetal Neonatal (ed.). 2014; 99: F315-F320
• 2 Sivieri EM, Gerdes JS, Abbasi S. Effect of HFNC flow rate, cannula size, and nares diameter on generated airway pressures: An in vitro study. Pediatr Pumonol 2013; 48: 506-514
• 3 Hough JL, Shearman AD, Jardine LA et al. Humified high flow nasal cannulae: Current practice in Australasian nurseries, a survey. J Paediatr Child Health 2012; 48: 106-113
• 4 Ojha S, Gridley E, Dorlin J. Use of heated huminfied high-flow nasal cannula oxygen in neonates: a UK wide survey. Acta Pediatr 2013; 102: 249-253
• 5 Abdel-Hady H, Shouman B, Aly H. Early weaning from CPAP to high flow nasal cannula in preterm infants is associated with prolonged oxygen requirement: a randomized controlled trial. Early Hum Dev 2011; 87: 205-208
• 6 Iranpour R, Sadeghnia A, Hesaraki M. High-flow nasal cannula versus nasal continuous positive airway pressure in the management of respiratory distress syndrome. J Isfahan Med School 2011; 29: 761-771
• 7 Sreenan C, Lemke RP, Hudson-Mason A et al. High-flow nasal cannulae in the management of apnea of prematurity: a comparison with conventional nasal continuous positive airway pressure. Pediatics 2001; 107: 1081-1083
• 8 Manley BJ, Owen LS, Doyle LW et al. High-Flow Nasal Cannulae in Very Preterm Infants after Extubation. N Engl J Med 2013; 369: 1425-1433
• 9 Manley BJ, Dold SK, Davis PG et al. High-Flow Nasal Cannulae for Respiratory Support of Preterm Infants: A Review of the Evidence. Neonatology 2012; 102: 300-308
• 10 Klingenberg C, Pettersen M, Hansen EA et al. Patient comfort during treatment with heated humidified high flow nasal cannulae versus nasal continuous positive airway pressure: a randomised cross-over trial. Arch Dis Child Fetal Neonatal Ed 2014; 99: F134-F137
• 11 Wilkinson DJ, Andersen CC, Smith K et al. Pharyngeal pressure with high-flow nasaö cannulae in premature infants. J Perinatol 2008; 28: 42-47
• 12 Lampland AL, Plumm B, Meyers PA et al. Observational study of humidified high-flow nasal cannula compared with nasal continuous positive airway pressure. J Pediatr 2009; 154: 177-182
• 13 Collins CL, Holberton JR, Barfiel C et al. A randomized controlled trial to compare heated humidified high-flow nasal cannulae with nasal continuous positive airway pressure postextubation in premature infants. J Pediatr 2013; 162: 949-954
• 14 Yoder BA, Stoddard RA, Li M et al. Heated, humified high-flow nasal cannula versus nasal CPAP for respiratory support in neonates. Pediatrics 2013; 131: e1482-e1490
• 15 Kugelman A, Riskin A, Said W et al. A randomized pilot study comparing heated humified high-flow nasal cannulae with NIPPV for RDS. Pediatr Pulmonol 2014; [Epub ahead of print]
• 16 Jasin LR, Kern S, Thompson S et al. Subcutaneous scalp emphysema, pneumo-orbitis and pneumocephalus in a neonate on high humidity high flow nasal cannula. J Perinatol 2008; 28: 779-781