High-Flow Nasal Cannulae in Very Preterm Infants After Extubation

Abstract

Abstract The HIPERSPACE trial compared high-flow nasal cannula (HFNC) with continuous positive airway pressure (CPAP) as post-extubation support, at a time when HFNC was being increasingly used for this indication, with minimal guiding evidence. In this multicenter, non-inferiority trial, 303 infants <32 weeks’ gestation were randomized to either 6 to 8 cm H2O CPAP or 5 to 8 L/min HFNC after extubation. HFNC was found to be noninferior to CPAP for the primary outcome of extubation failure within 7 days, with a 20% margin of non-inferiority (34.2% HFNC versus 25.8% CPAP; risk difference [RD] 8.4, 95% CI –1.9 to 18.7). For infants with GA <26 weeks’ (n = 62), failure rate was high in both treatment groups, but the RD was 20% in favor of CPAP (95% CI –1.9 to 41.8). Apart from less nasal trauma in the HFNC group, no statistically significant difference was observed between groups for secondary outcomes.