A randomised trial comparing weaning from CPAP alone with weaning using heated humidified high flow nasal cannula in very preterm infants: the CHiPS study

OBJECTIVE: To determine whether weaning from nasal continuous positive airway pressure (nCPAP) using heated humidified high flow nasal cannula (nHF) was non-inferior to weaning using nCPAP alone in relation to time on respiratory support. STUDY DESIGN: Single-centre, non-inferiority, randomised controlled trial. SETTING: Neonatal Intensive Care Unit, Middlemore Hospital, Auckland, New Zealand. PATIENTS: 120 preterm infants, <30 weeks’ gestation at birth, stable on nCPAP for at least 48 hours. INTERVENTIONS: Infants underwent stratified randomisation to nHF 6 L/min or bubble CPAP 6 cm water. In both groups, stepwise weaning of their respiratory support over 96 hours according to a strict weaning protocol was carried out. MAIN OUTCOME MEASURES: Time on respiratory support from randomisation to 72 hours off respiratory support or 36 weeks’ postmenstrual age. The non-inferiority threshold was set at 15%. RESULTS: 59 infants were randomised to weaning using nHF and 61 using nCPAP. The groups were well balanced in regards to baseline demographics. The restricted mean duration of respiratory support following randomisation for the nCPAP group, using per-protocol analysis was 401 hours (upper boundary, mean plus 0.15, was 461 hours) and 375 hours in the nHF group (upper 95% CI 413 hours). nHF weaning was, therefore, non-inferior to nCPAP weaning at the non-inferiority threshold. There was no significant difference in time to discharge. CONCLUSION: For infants ready to wean from nCPAP, the CHiPS study found that nHF was non-inferior to discontinuing nCPAP at 5 cm water. TRIAL REGISTRATION NUMBER: Australia and New Zealand Clinical Trials Registry (ACTRN12615000077561).