title: A comparison of nasal trauma in preterm infants extubated to either heated humidified high-flow nasal cannulae or nasal continuous positive airway pressure.
abstract: The objectives of this study were (1) to devise a nasal trauma score for preterm infants receiving non-invasive respiratory support, (2) to compare the incidence of nasal trauma in preterm infants <32 weeks gestation randomised to either nasal continuous positive airway pressure (NCPAP) or heated humidified high-Flow nasal cannulae (HHHFNC), in the first 7 days post-extubation and (3) to assess the effect of two different nasal dressings in those assigned to NCPAP. We randomly assigned preterm ventilated infants to receive Vapotherm® HHHFNC or NCPAP post-extubation. Infants receiving HHHFNC were treated with Sticky Whiskers® and infants receiving NCPAP received either Sticky Whiskers® or Cannualaide® nasal dressings. Bedside nursing staff scored six sites on each infant's nose for erythema, bleeding or ulceration. Scores were recorded three times daily for the first 7 days post-extubation. The sum of these 21 scores was used as the summary measure of nasal trauma. The mean nasal trauma score for infants assigned HHHFNC was 2.8 (SD 5.7) compared to 11.7 for NCPAP (SD 10.4), p < 0.001. There was no difference in mean trauma score between infants on NCPAP assigned Sticky Whiskers® 14.4 (SD 12.5) or Cannualaide® 9.5 (SD 7.3), p = 0.06.
  
  
  CONCLUSIONS
  HHHFNC resulted in significantly less nasal trauma in the first 7 days post-extubation than NCPAP and was most significant in infants <28 weeks of gestation. The use of protective dressings was not associated with decreased nasal trauma for infants on NCPAP.
authors: Mercy Hospital for Women, Melbourne, Australia, ccollins@mercy.com.au.
authors: C L
authors: CL
authors: Collins
authors: C
authors: C
authors: Barfield
authors: R S C
authors: RS
authors: Horne
authors: P G
authors: PG
authors: Davis
mesh_terms: D060666:Airway Extubation / Q000009:adverse effects* / Q000295:instrumentation*; D001458:Bandages; D057785:Catheters / Q000009:adverse effects*; D045422:Continuous Positive Airway Pressure / Q000009:adverse effects* / Q000295:instrumentation*; D004844:Epistaxis / Q000145:classification / Q000209:etiology; D004867:Equipment Design; D004890:Erythema / Q000145:classification / Q000209:etiology; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007235:Infant, Premature, Diseases / Q000628:therapy*; D008297:Male; D009666:Nose / Q000293:injuries*; D012131:Respiratory Insufficiency / Q000628:therapy*; D015599:Trauma Severity Indices; D014456:Ulcer / Q000145:classification / Q000209:etiology
references: Pediatrics. 2005 Mar;115(3):e262-8
references: 15687417
references: Adv Skin Wound Care. 2007 Apr;20(4):208, 210, 212, 214, 216, 218-20
references: 17415029
references: Rev Lat Am Enfermagem. 2009 Jul-Aug;17(4):489-94
references: 19820855
references: Arch Dis Child Fetal Neonatal Ed. 2010 Nov;95(6):F447-51
references: 20584802
references: Biomed Instrum Technol. 2011 Jan-Feb;45(1):69-74
references: 21322815
references: Int Wound J. 2010 Oct;7(5):323-8
references: 20840181
references: J Hosp Infect. 1997 Jan;35(1):37-45
references: 9032634
references: Respir Care. 2011 Jul;56(7):1040-2
references: 21352666
references: Int J Pediatr Otorhinolaryngol. 2006 Aug;70(8):1369-73
references: 16564097
references: Arch Otolaryngol Head Neck Surg. 2010 Mar;136(3):287-91
references: 20231649
references: Nurs Times. 2005 Mar 15-21;101(11):40-3
references: 15793956
references: Arch Dis Child Fetal Neonatal Ed. 2005 Nov;90(6):F480-3
references: 15941825
references: Arch Dis Child Fetal Neonatal Ed. 1996 Nov;75(3):F209-12
references: 8976689
references: J Pediatr. 2013 May;162(5):949-54.e1
references: 23260098
references: Indian Pediatr. 2010 Mar;47(3):265-7
references: 19430064