High-flow nasal cannula as a post-extubation respiratory support strategy in preterm infants: a systematic review and meta-analysis()()

OBJECTIVE: Perform a systematic review and meta-analysis to assess the effectiveness and complications caused by the use of the high-flow nasal cannula in relation to the post-extubation continuous positive airway pressure system in preterm newborns. DATA SOURCES: The searches were performed from January 2013 to December 2018 in the PubMed and Embase databases, as well as a manual search on the internet. DATA SYNTHESIS: Two reviewers independently conducted the search, and a third reviewer resolved questions that arose. Ninety-eight articles from the chosen sources were evaluated, and 66 were discarded because they did not meet the inclusion criteria (inadequate topic, age range, or design, in addition to the duplicates). Fifteen articles were read in full, and five more were discarded due to inadequacy to the topic or design. There were ten articles left for systematic review and four for meta-analysis. The study showed non-inferiority in terms of therapeutic failure of the high-flow nasal cannula in relation to continuous positive airway pressure after extubation of preterm newborns. In the meta-analysis, nasal trauma was significantly lower in patients submitted to the high-flow nasal cannula compared to those using continuous positive airway pressure (p < 0.00001). CONCLUSION: The high-flow nasal cannula is not inferior to continuous positive airway pressure for post-extubation respiratory support in preterm newborns with a gestational age of 32 weeks or less and greater than 28 weeks, in addition to resulting in less nasal trauma.