High-flow oxygen therapy in moderate to severe bronchiolitis: a randomised controlled trial
- PMID: 36941030
- DOI: 10.1136/archdischild-2022-324697
High-flow oxygen therapy in moderate to severe bronchiolitis: a randomised controlled trial
Abstract
Background and objective: High-flow (HF) oxygen therapy is being used increasingly in infants with bronchiolitis, despite lack of convincing evidence of its superiority over low flow (LF). We aimed to compare the effect of HF to LF in moderate to severe bronchiolitis.
Methods: Multicentre randomised controlled trial during four winter seasons (2016-2020) including 107 children under 2 years of age admitted with moderate to severe bronchiolitis, oxygen saturation of <92% and severely impaired vital signs. Crossovers were not allowed. HF was administered at flow rates of 2 L/kg for the first 10 kg, plus 0.5 L/kg for every kg >10 kg, LF with a maximum flow rate of 3 L/min. Primary outcome was improvement of vital signs and dyspnoea severity within 24 hours assessed by a composite score. Secondary outcomes were comfort, duration of oxygen therapy, supplemental feedings, hospitalisation duration and intensive care admission for invasive ventilation.
Results: Significant improvement within 24 hours occurred in 73% of 55 patients randomised to HF and in 78% of 52 patients with LF (difference 6%, 95% CI -13% to 23%). Intention-to-treat analysis revealed no significant differences in any secondary outcome: duration of oxygen therapy, supplemental feedings, hospitalisation and need for invasive ventilation or intensive care admission, except for comfort (face, legs, activity, cry, consolability), which was one point (out of a scale of 0-10) higher in the LF group. No adverse effects occurred.
Conclusion: We found no measurable clinically relevant benefit in the use of HF compared with LF in hypoxic children with moderate to severe bronchiolitis.
Trial registration number: NCT02913040.
Keywords: Paediatrics; Respiratory Medicine.
© Author(s) (or their employer(s)) 2023. No commercial re-use. See rights and permissions. Published by BMJ.
Conflict of interest statement
Competing interests: None declared.
Similar articles
-
Safety and Efficacy of Imatinib for Hospitalized Adults with COVID-19: A structured summary of a study protocol for a randomised controlled trial.Trials. 2020 Oct 28;21(1):897. doi: 10.1186/s13063-020-04819-9. Trials. 2020. PMID: 33115543 Free PMC article.
-
High-flow warm humidified oxygen versus standard low-flow nasal cannula oxygen for moderate bronchiolitis (HFWHO RCT): an open, phase 4, randomised controlled trial.Lancet. 2017 Mar 4;389(10072):930-939. doi: 10.1016/S0140-6736(17)30061-2. Epub 2017 Feb 2. Lancet. 2017. PMID: 28161016 Clinical Trial.
-
Early high flow nasal cannula therapy in bronchiolitis, a prospective randomised control trial (protocol): A Paediatric Acute Respiratory Intervention Study (PARIS).BMC Pediatr. 2015 Nov 14;15:183. doi: 10.1186/s12887-015-0501-x. BMC Pediatr. 2015. PMID: 26572729 Free PMC article. Clinical Trial.
-
Heliox inhalation therapy for bronchiolitis in infants.Cochrane Database Syst Rev. 2015 Sep 18;2015(9):CD006915. doi: 10.1002/14651858.CD006915.pub3. Cochrane Database Syst Rev. 2015. PMID: 26384333 Free PMC article. Review.
-
Nebulised deoxyribonuclease for viral bronchiolitis in children younger than 24 months.Cochrane Database Syst Rev. 2012 Nov 14;11(11):CD008395. doi: 10.1002/14651858.CD008395.pub2. Cochrane Database Syst Rev. 2012. PMID: 23152257 Free PMC article. Review.
Cited by
-
Normal saline for children with bronchiolitis: study protocol for a randomised controlled non-inferiority trial.BMJ Paediatr Open. 2024 Jan 17;8(1):e002273. doi: 10.1136/bmjpo-2023-002273. BMJ Paediatr Open. 2024. PMID: 38233083 Free PMC article.
-
Hyperoxia can Induce Lung Injury by Upregulating AECII Autophagy and Apoptosis Via the mTOR Pathway.Mol Biotechnol. 2023 Nov 8. doi: 10.1007/s12033-023-00945-2. Online ahead of print. Mol Biotechnol. 2023. PMID: 37938537
-
Nasal CPAP in the Pediatric Ward to Reduce PICU Admissions for Severe Bronchiolitis?Pediatr Rep. 2023 Oct 13;15(4):599-607. doi: 10.3390/pediatric15040055. Pediatr Rep. 2023. PMID: 37873801 Free PMC article.
Publication types
MeSH terms
Substances
Associated data
LinkOut - more resources
Full Text Sources
Medical
Research Materials
Miscellaneous