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It is in the nature of the relationship between industry and healthcare that devices and techniques generally have to come to market and establish themselves in use, before proper rigorous trials of their effectiveness can be done. So it has been with devices delivering ‘non-invasive ventilation’, meaning nasal intermittent positive pressure ventilation (nIPPV). Sadly, most of the trials have been small and have focused on one or two devices. It was therefore good to see Kirpalani and colleagues (N Engl J Med 2013;369:611–20) publish a pragmatic trial with over 1000 participants which showed that nIPPV (delivered by any device) performed no better or worse than nasal continuous positive airway pressure in terms of survival to 36 weeks postmenstrual age without continuing oxygen dependency among babies <30 weeks and <1000 g.
High-flow nasal cannula versus nasal CPAP
A similar development has been that of high-flow systems that deliver blended, heated and humidified oxygen/air via nasal cannulas at flows between about 1 and 6 L/min. These devices have proved popular with nurses, parents and babies as they seem to offer many of the benefits of nasal continuous positive airway …