Success Rate of Discontinuation of High-Flow Nasal Cannula at 4 LPM Compared to 2 LPM in Late Preterm and Term Neonates with Respiratory Distress

Objective: To compare the success rate of discontinuation of high-flow nasal cannula (HFNC) at a predefined flow of 4 liters per minute (LPMs) versus a predefined flow of 2 LPMs. Materials and Methods: This prospective randomized clinical trial was conducted in the neonatal units at Queen Sirikit National Institute of Child Health from October 2021 to March 2022. Infants who were receiving HFNC were randomly assigned to discontinuation of HFNC either at predefined flow 4 LPMs or 2 LPMs. The primary outcome was successful discontinuation of HFNC for 48 hours. Results: A total of 79 infants were enrolled in this study, of which 9 were excluded for a final analysis of 70 infants, 35 in each group. The success rate of discontinuation of HFNC was similar in both therapy groups (91.43% in the 4 LPMs group compared with 94.29% in the 2 LPMs group, P = .64). However, the predefined 4 LPMs group had a significantly shorter median HFNC duration (35 hours; interquartile range [IQR]: 23-85) compared with the 2 LPMs group (51 hours;IQR: 36-97) (P=.028). Conclusion: The successful discontinuation of HFNC at predefined flow 4 LPMs was similar to discontinuing at predefined flow 2 LPMs. Moreover, the median duration on HFNC was shorter in the 4 LPMs group. There is currently no evidence available to suggest the best strategy for weaning and discontinuation of HFNC.