Hemodynamic changes in preterm neonates with respiratory distress syndrome: high-flow nasal cannula versus nasal continuous positive airway pressure-a randomized controlled trial.

BACKGROUND

Non-invasive ventilation (NIV) in the form of heated humidified, high-flow nasal cannula (HHHFNC) or nasal continuous positive airway pressure (nCPAP) is widely used in preterm neonates with respiratory distress syndrome (RDS). We aimed to evaluate the impact of HHHFNC and nCPAP on cardiac, cerebral, and mesenteric hemodynamics.

METHODS

One hundred twenty-three hemodynamically stable, low birth weight preterm neonates <34 weeks with RDS who needed NIV were randomized to receive either HHHFNC or NCPAP. Echocardiographic parameters, including superior vena cava (SVC) flow, left ventricular output (LVO), and right ventricular output (RVO), as well as anterior cerebral artery (ACA) resistance index, and superior mesenteric artery (SMA) flow velocity and resistance, were assessed 1 h before and 1 h after weaning off respiratory support.

RESULTS

SMA flow increased after discontinuing HHHFNC and nCPAP (P˂0.001 and 0.001, respectively). SVC flow, RVO, LVO, and ACA resistance index did not show significant changes in either group. A negative correlation was observed between the highest positive end-expiratory pressure and SMA flow velocity (P = 0.002).

CONCLUSION

Both HHHFNC and nCPAP do not impact cardiac or cerebral hemodynamics. However, both modalities result in a reversible reduction in mesenteric blood flow. This trial was registered at ClinicalTrials.gov, identifier: NCT04238273.

IMPACT: Non-invasive ventilation (NIV), such as heated humidified, high-flow nasal cannula (HHHFNC) or nasal continuous positive airway pressure (nCPAP), is widely used in preterm neonates with respiratory distress syndrome (RDS). Using the current design, HHHFNC and nCPAP do not impact cardiac or cerebral hemodynamics. Both modalities result in a reduction in mesenteric blood flow. These changes are reversible upon discontinuation of respiratory therapy. A negative correlation was observed between positive end-expiratory pressure in nCPAP and SMA flow velocity. The use of HHHFNC and nCPAP is hemodynamically safe in neonates with RDS.