Abstract
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.
Abstract
This randomised trial found no evidence of lower rate of escalating respiratory support among patients receiving high-flow oxygen therapy admitted for a first episode of moderate bronchiolitis to the paediatric emergency department https://bit.ly/2xsvqJG
Footnotes
Published online 16 July, 2020; republished 29 July, 2020 with amendments to an author forename.
This article has an editorial commentary: https://doi.org/10.1183/13993003.01020-2020
This article has supplementary material available from erj.ersjournals.com
This study is registered on http://clinicaltrials.gov with identifier: NCT02856165. All the individual participant data collected during the trial will be made available after deidentification.
The following are members of the Bronchopti study group, listed in alphabetical order: Sakina Benkaddouss, Meaux Hospital; Priscilla Binet, Bicêtre University Hospital; Claire Bretagne, Béclère University Hospital; Anne Chace, Villeneuve Saint George Hospital; Edwidge Dakouri, Villeneuve Saint George Hospital; Yvan De La Monneraye, Ambroise Paré University Hospital; Céline Delestrain, Intercommunal Creteil Hospital; Leila Destruys, Bicêtre University Hospital; Danielle Dubrez, Villeneuve Saint George Hospital; Marc Duval-Arnould, Bicêtre University Hospital; Rachel El Samad, Meaux Hospital; Boris Gbacko, Melun Hospital; Emilie Georget, Villeneuve Saint George Hospital; Charlotte Girod, Orsay Hospital; François Gouraud, Meaux Hospital; Claire Grinwood, Ambroise Paré University Hospital; Thomas Hellwig, Fontainebleau Hospital; Maud Kernemp, Poissy Hospital; Marie Khelfa, Chartres Hospital; Aurélie Lemaire, Poissy Hospital; Iulia Marian, Orsay Hospital; Laurence Mathivon, Meaux Hospital; Elodie Merlot and Marie Monfort, Meaux Hospital; Gabrielle Naudet, Villeneuve Saint George Hospital; Laure Picard, Chartres Hospital; Delphine Regnard, Bicêtre University Hospital; Noureddine Riahi, Chartres Hospital; Charlotte Rougeoreille, Melun Hospital; Nathalie Sannier, Montargis Hospital; Clémentine Specht, Béclère University Hospital; Andrea Valean, Ambroise Paré University Hospital; Cécile Yakovleff, Poissy Hospital; Edwige D.A. Zoclanclounon, Chartres Hospital.
Conflict of interest: P. Durand has nothing to disclose.
Conflict of interest: T. Guiddir has nothing to disclose.
Conflict of interest: C. Kyheng has nothing to disclose.
Conflict of interest: F. Blanc has nothing to disclose.
Conflict of interest: O. Vignaud has nothing to disclose.
Conflict of interest: R. Epaud has nothing to disclose.
Conflict of interest: F. Dugelay has nothing to disclose.
Conflict of interest: I. Breant has nothing to disclose.
Conflict of interest: I. Badier has nothing to disclose.
Conflict of interest: V. Degas-Bussière has nothing to disclose.
Conflict of interest: F. Phan has nothing to disclose.
Conflict of interest: V. Soussan-Banini has nothing to disclose.
Conflict of interest: A. Lehnert has nothing to disclose.
Conflict of interest: C. Mbamba has nothing to disclose.
Conflict of interest: C. Barrey has nothing to disclose.
Conflict of interest: C. Tahiri has nothing to disclose.
Conflict of interest: M. Decobert has nothing to disclose.
Conflict of interest: M. Saunier-Pernaudet has nothing to disclose.
Conflict of interest: I. Craiu has nothing to disclose.
Conflict of interest: M. Taveira has nothing to disclose.
Conflict of interest: V. Gajdos has nothing to disclose.
Support statement: The study was funded by a grant from Programme Hospitalier de Recherche Clinique – PHRC 2016 (Ministère de la santé AORC 14056, P150931/IDRCB 2016-A00568-43). High-flow oxygen therapy devices and consumable materials were supplied by Fisher & Paykel Healthcare, Auckland, New Zealand. Funding information for this article has been deposited with the Crossref Funder Registry.
- Received October 3, 2019.
- Accepted March 23, 2020.
- Copyright ©ERS 2020
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