Randomised controlled trial of oxygen therapy and high-flow nasal therapy in African children with pneumonia

Area of Science:

• Pediatric critical care
• Respiratory medicine
• Global health

Background:

• Severe pneumonia is a leading cause of mortality in African children.
• The optimal respiratory support strategy for children with severe pneumonia and hypoxemia in low-resource settings remains unclear.
• Oxygen therapy is crucial, but its specific role and delivery methods require further investigation.

Purpose of the Study:

• To establish the life-saving role of oxygen therapy in African children with severe pneumonia.
• To compare the efficacy of high-flow nasal therapy (HFNT) versus low-flow oxygen (LFO) in children with severe pneumonia and varying degrees of hypoxemia.
• To evaluate mortality and neurocognitive outcomes associated with different respiratory support strategies.

Main Methods:

• The COAST trial was an open-label, fractional-factorial randomized trial conducted in Uganda and Kenya.
• Eligible children aged >28 days with severe pneumonia and hypoxemia (SpO2 < 80% or 80-91%) were randomized to HFNT or LFO.
• The primary endpoint was 48-hour mortality, with secondary endpoints including 28-day mortality and neurocognitive sequelae.

Main Results:

• The trial enrolled 1852 children and was stopped early.
• In the severe hypoxemia stratum, 48-hour mortality was 9.3% for HFNT vs. 13.4% for LFO.
• In the hypoxemia stratum, 48-hour mortality was 1.1% for HFNT vs. 2.5% for LFO and 1.4% for permissive hypoxemia. 28-day mortality rates varied significantly by stratum and treatment.

Conclusions:

• High-flow nasal therapy (HFNT) demonstrated potential benefits in reducing mortality among African children with severe pneumonia and hypoxemia.
• The findings suggest that HFNT may be a valuable respiratory support option in resource-limited settings.
• Further research through additional trials is warranted to confirm these promising results and optimize treatment protocols.