Nursing perceptions of high-flow nasal cannulae treatment for very preterm infants

J Paediatr Child Health. 2014 Oct;50(10):806-10. doi: 10.1111/jpc.12636. Epub 2014 Jun 18.


Aim: This study aims to assess nursing perceptions of high-flow nasal cannulae (HFNC) in comparison with nasal continuous positive airway pressure (NCPAP) as post-extubation respiratory support for very preterm infants.

Methods: A standardised questionnaire form was distributed in person to nursing staff in The Royal Women's Hospital neonatal unit, where HFNC had been recently introduced in the context of a clinical trial. Nursing staff were eligible to participate if they routinely cared for infants receiving respiratory support.

Results: The survey was completed by 99/144 eligible nurses. The majority of the 99 nurses surveyed felt that HFNC was less likely than NCPAP to prevent re-intubation of infants 24-26 weeks' gestation but equally likely to prevent re-intubation of infants 28-30 weeks' gestation. Nurses preferred NCPAP for post-extubation support of 24- and 26-week infants, and HFNC for 28- and 30-week infants, despite being less experienced with HFNC. Perceptions of HFNC compared with NCPAP included increased ease-of-use, improved infant comfort and reduced nasal trauma.

Conclusions: Neonatal nurses preferred NCPAP for post-extubation support of infants <28 weeks' gestation and HFNC for infants of 28 or 30 weeks' gestation. Nurses accurately predicted varying efficacy of HFNC across different gestational ages, consistent with the findings of a contemporaneous randomised trial. In the context of clinical non-inferiority, as shown in the randomised trial, nursing preference for HFNC over NCPAP in preterm infants ≥28 weeks' gestation supports the use of HFNC as post-extubation support in this population.

Keywords: continuous positive airway pressure; high-flow nasal cannulae; infant; nursing practice; premature; questionnaire.

MeSH terms

  • Adult
  • Airway Extubation / methods
  • Airway Extubation / nursing
  • Attitude of Health Personnel
  • Catheterization / methods
  • Catheterization / nursing
  • Continuous Positive Airway Pressure / methods
  • Continuous Positive Airway Pressure / nursing*
  • Female
  • Gestational Age
  • Humans
  • Infant, Extremely Premature*
  • Infant, Newborn
  • Intensive Care Units, Neonatal
  • Male
  • Neonatal Nursing / methods
  • Nursing Assessment
  • Nursing Staff, Hospital
  • Oxygen Inhalation Therapy / methods
  • Oxygen Inhalation Therapy / nursing*
  • Respiratory Insufficiency / diagnosis
  • Respiratory Insufficiency / therapy
  • Surveys and Questionnaires*