ABSTRACT Objective To assess lung aeration changes during clinically directed transitions from CPAP to HFNC in preterm infants using Electrical Impedance Tomography (EIT). Design Prospective, observational study. Setting Single‐center, Level IV Neonatal Intensive Care Unit. Patients Infants born < 32 weeks gestational age (GA) undergoing a clinically indicated transition from CPAP to HFNC following ≥ 2 weeks of respiratory support. Interventions EIT data were recorded for 30–60 min before and after transition. Main Outcome Measures The primary outcome was change in end‐expiratory lung impedance (ΔEELI). Infants were followed for 7 days following transition to assess for transition failure. Results From 15 subjects, 4257 total breaths were analyzed. No significant difference in %∆EELI was found between HFNC and CPAP (Median ∆: –1.0%; IQR –3.6% to 6.0%; p = 0.78). The largest %∆EELI decrease (–9.8%) occurred in the subject who failed transition. Conclusions Transitioning from CPAP to HFNC did not consistently decrease lung aeration in stable preterm infants. In the infant who failed transition, a distinct respiratory pattern was observed using EIT, characterized by a decrease in EELI and frequent recruitment breaths. These findings suggest better methods are needed to individualize and titrate respiratory support at the bedside for preterm infants.
Rub et al. (2025) studied this question.