High-flow Nasal Cannulae as Post-extubation Respiratory Support in Premature Infants: A Continuus Positive Airway Pressure Equivalent? (The HIPERSPACE Trial)

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HIPERSPACE is a trial comparing the use of two types of breathing support for premature infants after they have been extubated (come off a mechanical breathing machine) in the Royal Women’s Hospital (RWH), Adelaide Women's and Children's Hospital (WCH) or Royal Brisbane and Women's Hospital (RBWH) neonatal intensive care units. Premature infants who are born less than 32 weeks of gestation, required support from a mechanical breathing machine, and are planned to be extubated to further breathing support are eligible for inclusion in the trial. The usual way post-extubation breathing support has been provided is by using large prongs in the babies’ nose which transmit a continuous, and regulated, pressure to the baby’s lungs to help them breathe more easily. This support, called nasal CPAP, is quite bulky and requires the infant to wear a tightly-fitted hat, and sometimes causes damage to the infants’ nose. A newer form of support being used around Australian and the world is called high-flow nasal cannulae (HFNC). This method uses smaller prongs in the infant’s nose and blows gas at 2-8 litres per minute into the infant’s airway. It is thought this flow also produces a pressure that helps to keep the lungs open, and has been considered to be more comfortable for the infants. However, despite widespread use, HFNC has not been well studied in premature infants. In the HIPERSPACE trial, premature infants who have been extubated will be randomly assigned to receive either nCPAP or HFNC. The main result we will be interested in from the trial will be which treatment the infants do better on. Infants in the HFNC group who are not coping can be offered nCPAP as ‘rescue’ treatment. Information will be collected about the infants until they are discharged from hospital, including the incidence of lung complications, the amount of different types of breathing support required, rates of complications from using the different types of prongs in the nose, and the comfort of the infant.