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A randomised trial of high-flow nasal cannula in infants with moderate bronchiolitis
Philippe Durand1, Tamma Guiddir1, Christèle Kyheng1
1Pediatric Emergency Dept, Bicêtre University Hospital, Assistance Publique-Hôpitaux de Paris, Kremlin-Bicêtre, France.
Insights
High-flow nasal cannula (HFNC) did not reduce treatment failure in infants with moderate bronchiolitis. This respiratory support method did not lower the need for escalated care compared to standard oxygen therapy.
Area of Science:
- Pediatrics
- Respiratory Medicine
- Clinical Trials
Background:
- Infant bronchiolitis is a common respiratory illness.
- High-flow nasal cannula (HFNC) is a respiratory support method with potential benefits.
- Escalation of care is a significant concern in managing moderate bronchiolitis.
Purpose of the Study:
- To evaluate if HFNC reduces treatment failure in infants with moderate bronchiolitis.
- To compare HFNC with standard oxygen therapy in this patient population.
- To assess the need for escalated respiratory support within 7 days.
Main Methods:
- Randomized controlled trial involving infants under 6 months with moderate bronchiolitis.
- Comparison between HFNC (3 L·kg⁻¹·min⁻¹) and standard oxygen therapy.
- Primary outcome: proportion of patients requiring escalated care; Secondary outcomes: PICU transfer, oxygen use, adverse events.
Main Results:
- Treatment failure occurred in 14% of HFNC recipients versus 20% of controls (p=0.21).
- No significant difference in PICU transfer rates between groups (15% vs 19%, p=0.45).
- HFNC showed short-term benefits in modified Wood clinical asthma score and respiratory rate, but three pneumothoraces were reported.
Conclusions:
- HFNC therapy did not demonstrate a lower rate of escalated respiratory support in moderate bronchiolitis.
- No significant reduction in treatment failure or PICU admission was observed.
- Further research may be needed to clarify the role of HFNC in infant bronchiolitis management.
Background:
The objective was to determine whether high-flow nasal cannula (HFNC), a promising respiratory support in infant bronchiolitis, could reduce the proportion of treatment failure requiring escalation of care.
Methods:
In this randomised controlled trial, we assigned infants aged <6 months who had moderate bronchiolitis to receive either HFNC at 3 L·kg-1·min-1 or standard oxygen therapy. Crossover was not allowed. The primary outcome was the proportion of patients in treatment failure requiring escalation of care (mostly noninvasive ventilation) within 7 days following randomisation. Secondary outcomes included rates of transfer to the paediatric intensive care unit (PICU), oxygen, number of artificial nutritional support-free days and adverse events.
Results:
The analyses included 268 patients among the 2621 infants assessed for inclusion during two consecutive seasons in 17 French paediatric emergency departments. The percentage of infants in treatment failure was 14% (19 out of 133) in the study group, compared to 20% (27 out of 135) in the control group (OR 0.66, 95% CI 0.35-1.26; p=0.21). HFNC did not reduce the risk of admission to PICU (21 (15%) out of 133 in the study group versus 26 (19%) out of 135 in the control group) (OR 0.78, 95% CI 0.41-1.41; p=0.45). The main reason for treatment failure was the worsening of modified Wood clinical asthma score (m-WCAS). Short-term assessment of respiratory status showed a significant difference for m-WCAS and respiratory rate in favour of HFNC. Three pneumothoraces were reported in the study group.
Conclusions:
In patients with moderate bronchiolitis, there was no evidence of lower rate of escalating respiratory support among those receiving HFNC therapy.
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