Strategies for the discontinuation of humidified high flow nasal cannula (HHFNC) in preterm infants

Farley, Raymond C., Hough, Judith L. and Jardine, Luke A. (2015) Strategies for the discontinuation of humidified high flow nasal cannula (HHFNC) in preterm infants. Cochrane Database of Systematic Reviews, 6 6: . doi:10.1002/14651858.CD011079.pub2

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Author Farley, Raymond C.
Hough, Judith L.
Jardine, Luke A.
Title Strategies for the discontinuation of humidified high flow nasal cannula (HHFNC) in preterm infants
Journal name Cochrane Database of Systematic Reviews   Check publisher's open access policy
ISSN 1469-493X
Publication date 2015
Sub-type Critical review of research, literature review, critical commentary
DOI 10.1002/14651858.CD011079.pub2
Open Access Status Not Open Access
Volume 6
Issue 6
Total pages 12
Place of publication Oxford, United Kingdom
Publisher John Wiley & Sons
Collection year 2016
Language eng
Formatted abstract
Background:  Humidified high flow nasal cannula (HHFNC) delivers humidified gas at increased flow rates via binasal prongs and is becoming widely accepted as a method of non-invasive respiratory support for preterm infants. While indications for the use of (HHFNC) and its associated risks and benefits are being investigated, the best strategy for the discontinuation of HHFNC remains unknown. At what point an infant is considered stable enough to attempt to start withdrawing their HHFNC is not known. The criteria for a failed attempt at HHFNC discontinuation is also unclear.

Objectives:  To determine the risks and benefits of different strategies used for the discontinuation of HHFNC in preterm infants.

Search methods:  We searched the Cochrane Neonatal Review Group Specialized Register, PubMed (1966 to March 2015), CINAHL (1982 to March 2015), EMBASE (1980 to March 2015), and the Cochrane Central Register of Controlled Trials (CENTRAL). Also, we checked previous reviews, including cross references. We searched for following web sites for ongoing trials: and

Selection criteria:  
We included randomised controlled trials (RCTs) and quasi-RCTs in which either individual newborn infants or clusters of infants (such as separate neonatal units) were randomised to different HHFNC withdrawal strategies (from the first time they come off HHFNC and any subsequent weaning, or withdrawal attempt, or both).

Data collection and analysis:  We used standard methods of Cochrane and the Cochrane Neonatal Review Group.

Main results:  We identified no eligible studies examining the best strategy to wean or withdraw HHFNC once started as respiratory support in preterm infants

Authors' conclusions:  There is currently no evidence available to suggest the best strategy for weaning and withdrawing HHFNC as a respiratory support in preterm infants. Research is required into the best strategy for withdrawal of HHFNC and to which subgroups this applies. Clear criteria for the definition of stability prior to attempting to withdraw HHFNC needs to be established. Furthermore, clear definitions are needed as to what constitutes failure of HHFNC.
Keyword Respiratory support
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Critical review of research, literature review, critical commentary
Collections: Mater Research Institute-UQ (MRI-UQ)
Official 2016 Collection
School of Medicine Publications
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