Nasal High-Flow Therapy vs Standard Care During Neonatal Endotracheal Intubation

In this randomized controlled trial, nasal high-flow therapy was compared with standard care (no nasal high-flow therapy or supplemental oxygen) in neonates undergoing oral endotracheal intubation at two neonatal intensive care units. The primary outcome was successful intubation on the first attempt without physiological instability (defined as an absolute decrease in the peripheral oxygen saturation of >20% from the pre intubation, baseline level or bradycardia with a heart rate of <100 beats per minute) in the infant. At the time of intubation, infants had a median postmenstrual age of 27.9 weeks and a median weight of 920 g. The primary intention-to-treat analysis included the outcomes of 251 intubations in 202 infants; 124 intubations were assigned to the high-flow group and 127 to the standard-care group. A successful intubation on the first attempt without physiological instability was achieved in 62 of 124 intubations (50%) in the high-flow group and in 40 of 127 intubations (31.5%) in the standard-care group (adjusted risk difference, 17.6 percentage points; 95% CI, 6.0 to 29.2), for a number needed to treat of 6 (95% CI, 4 to 17) for 1 infant to benefit. Successful intubation on the first attempt regardless of physiological stability was accomplished in 68.5% of the intubations in the high-flow group and in 54.3% of the intubations in the standard-care group (adjusted risk difference, 15.8 percentage points; 95% CI, 4.3 to 27.3). The authors concluded that among infants undergoing endotracheal intubation at two Australian tertiary neo-natal intensive care units, nasal high-flow therapy during the procedure improved the likelihood of successful intubation on the first attempt without physiological instability in the infant.