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High-Flow Nasal Oxygen for Neonatal Intubation

June 28, 2022

Written by Vivian Lei

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Intubating neonates with high-flow nasal oxygen therapy improves chances of successful intubation on the first attempt without physiological instability.

Why does this matter?
Intubating sick neonates is difficult, and intubation attempts are often abandoned due to physiological instability. Nasal high-flow oxygen therapy has been used successfully in adults and older children to extend the safe apneic window and may be a useful adjunct to neonatal intubations where first pass success is relatively low.

High-flow O’s for a neonate’s nose
In this randomized controlled trial conducted at 2 NICUs in Melbourne, Australia, premature infants (average weight <1kg) requiring intubation were randomized to high-flow therapy (8 L/min) or standard care (no high-flow) prior to the first intubation attempt. A total of 251 intubations were included in an intent-to-treat analysis, with 124 in the high-flow group and 127 in the standard-care group. Intubation on the first attempt without physiological instability was achieved in 50% of the high-flow group, compared to 31.5% in the standard-care group. This equates to a NNT of 6. Infants on high-flow therapy were more likely to be intubated successfully on the first attempt and less likely to desaturate, and this effect benefited inexperienced operators the most. Applying nasal high-flow oxygen seems like a simple and effective way to improve intubation success in the smallest of patients.

Nasal High-Flow Therapy during Neonatal Endotracheal Intubation. N Engl J Med. 2022 Apr 28;386(17):1627-1637. doi: 10.1056/NEJMoa2116735.

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