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HFNC - will the HIPSTER trial affect your clinical practises?


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The HIPSTER trial was published in NEJM the other week and it showed clearly that HFNC was inferior to nasal CPAP in the initial management of preterm infants (≥28 weeks). You can read the paper here: http://www.nejm.org/doi/full/10.1056/NEJMoa1603694

@AllThingsNeonatal wrote a great blog post about his reflections on the paper. 

I would be great to hear about your non-invasive ventilatory support practises. Does anyone use HFNC as initial support, if so, what are your strategies and guidelines?

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On 10/2/2016 at 3:11 PM, Stefan Johansson said:

The HIPSTER trial was published in NEJM the other week and it showed clearly that HFNC was inferior to nasal CPAP in the initial management of preterm infants (≥28 weeks). You can read the paper here: http://www.nejm.org/doi/full/10.1056/NEJMoa1603694

@AllThingsNeonatal wrote a great blog post about his reflections on the paper. 

I would be great to hear about your non-invasive ventilatory support practises. Does anyone use HFNC as initial support, if so, what are your strategies and guidelines?

3

We actually usually use HFNC as a step down from CPAP. However, sometimes we give it a try from the start after extubation in preterms who are doing well and have a good compliance " static compliance" on Resp. function test before extubation. Our starting flow is about 3~5 L/Kg.

We weaning we go at a rate of 0.5 L q 12 hrs.

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We dont use HFNC as a Initial Support For Premies under 32 Weeks. 

Therefore was a lot of unreflected use as CPAP-Weaning Strategy: since we started with "the Todd-Procedere" Premies loose CPAP earlier without the need of HFNC. 

We use HFNC instead of CPAP For late preterms with TTPN with heavy breathing to lower our Airleak rate.

 

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