BackgroundThis study aims to compare the efficacy and complications of CPAP with HHHFNC, as post-extubation modalities for respiratory support in neonates.MethodsA comprehensive search was conducted in five electronic databases: MEDLINE (via PUBMED), Scopus, Web of Science, Google Scholar, and Embase in September 2022; screening observational and clinical trial studies for eligibility. Primary outcomes of the study included extubation failure at 72 hours and at 7 days.ResultsNine clinical trials were included, encompassing 1471 infants. Extubation failure at 72 days was more common with HHHFNC although insignificantly (OR = 3.40, 95% CI: 0.87, 13.23), but it was found to be significantly higher at 7 days when opting for HHHFNC (OR = 1.65, 95% CI: 1.02, 2.67). In an overall analysis, extubation failure was significantly higher in infants treated with HHHFNC (OR = 1.61, 95% CI: 1.14, 2.26). Among secondary outcomes, nasal trauma was significantly higher when CPAP was utilized (OR = 0.20 95% CI: 0.10, 0.42). Meta-analysis suggests that there are no differences in the risks for BPD (OR = 1.27, 95% CI: 0.79, 2.06), ROP (OR = 0.88, 95% CI: 0.51, 1.52), NEC (OR = 0.63, 95% CI: 0.41, 0.97), PVL (OR = 0.71, 95% CI: 0.29, 2.96), IVH (OR = 1.04, 95% CI: 0.53, 2.04), and mortality (OR = 0.96, 95% CI: 0.56, 1.66).ConclusionAccording to our review, CPAP remains the choice of non-invasive respiratory support modality regarding its lower risk for extubation failure. Although nasal trauma continues to be a challenging side effect for neonates treated with CPAP, other neonatal complications are equally prevalent when comparing CPAP and HHHFCN.

Keywords: CPAP; HHHFNC; extubation; respiratory support.

背景：本研究旨在比较CPAP与HHHFNC作为新生儿拔管后呼吸支持方式的有效性和并发症。
方法：在2022年9月，对五个电子数据库（MEDLINE（通过PUBMED）、Scopus、Web of Science、Google Scholar和Embase）进行了全面检索，筛选符合标准的观察性研究和临床试验。
主要结果包括72小时和7天内的拔管失败率。

九项临床试验被纳入分析，涵盖1471名婴儿。虽然在72小时内使用HHHFNC的拔管失败率略高（OR = 3.40，95% CI：0.87, 13.23），但选择HHHFNC时，在第7天拔管失败的风险显著增加（OR = 1.65，95% CI：1.02, 2.67）。总体分析表明，使用HHHFNC治疗的婴儿在拔管失败率上显著高于CPAP组（OR = 1.61，95% CI：1.14, 2.26）。次级结果中，鼻创伤在使用CPAP时更为常见（OR = 0.20，95% CI：0.10, 0.42）。荟萃分析表明，在BPD（呼吸窘迫综合征）、ROP（视网膜病变）、NEC（坏死性小肠结肠炎）、PVL（脑室周围白质软化症）、IVH（颅内出血）和死亡率的风险方面，CPAP与HHHFNC之间没有显著差异（OR = 1.27, 95% CI: 0.79, 2.06；OR = 0.88, 95% CI: 0.51, 1.52；OR = 0.63, 95% CI: 0.41, 0.97；OR = 0.71, 95% CI: 0.29, 2.96；OR = 1.04, 95% CI: 0.53, 2.04；OR = 0.96, 95% CI: 0.56, 1.66）。

结论：根据我们的回顾，CPAP仍然是非侵入性呼吸支持方式的首选，因其拔管失败的风险较低。尽管鼻创伤是使用CPAP治疗新生儿的一个持续挑战，但与其他并发症相比，在比较CPAP和HHHFNC时，其他新生儿并发症的发生率相当。

CPAP；HHHFNC；拔管；呼吸支持。