High-flow oxygen therapy in moderate to severe bronchiolitis: a randomised controlled trial

Area of Science:

• Pediatrics
• Respiratory Medicine
• Critical Care

Background:

• High-flow (HF) oxygen therapy is increasingly used for infants with bronchiolitis.
• Evidence supporting HF superiority over low-flow (LF) oxygen is limited.

Purpose of the Study:

• To compare the effectiveness of HF versus LF oxygen therapy in infants with moderate to severe bronchiolitis.
• To evaluate the impact on vital signs, dyspnea, and clinical outcomes.

Main Methods:

• Multicenter randomized controlled trial (2016-2020) involving 107 infants under 2 years.
• Comparison of HF (2 L/kg for first 10 kg, 0.5 L/kg thereafter) versus LF (max 3 L/min).
• Primary outcome: composite score of vital signs and dyspnea severity within 24 hours.

Main Results:

• No significant difference in primary outcome improvement between HF and LF groups (73% vs 78%).
• No significant differences in secondary outcomes including oxygen therapy duration, hospital stay, or need for invasive ventilation.
• Slightly higher comfort scores reported in the LF group.

Conclusions:

• HF oxygen therapy does not provide clinically relevant benefits compared to LF oxygen in hypoxic infants with moderate to severe bronchiolitis.
• Current evidence does not support the routine use of HF oxygen over LF oxygen for this patient population.