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 RCT, we assigned infants younger than 6 months who had moderate bronchiolitis to receive either HFNC at 3 L·kg−1·min−1 or standard oxygen therapy. Cross-over was not allowed. The primary outcome was the proportion of patient in treatment failure requiring escalation of care (mostly non-invasive ventilation) within 7-days following randomisation. Secondary outcome included rates of transfer in PICU, oxygen and nutritional-support length of days and adverse events.
Results The analyses included 268 patients among the 2621 infants assessed for inclusion during 2 consecutive seasons in 17 French pediatric emergency departments. The percentage of infants in treatment failure was 14% (19 of 133) in the study group, compared to 20% (27 of 135) in the control group (OR 0.66; CI 95% 0.35–1.26, p=0.21). HFNC did not reduce the risk of admission in PICU (21 of 133 in the study group (15%) versus 26 of 135 in the control group (19%))(OR 0.78; CI 95% 0.41–1.41, p=.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 favor 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.
Footnotes
This manuscript has recently been accepted for publication in the European Respiratory Journal. It is published here in its accepted form prior to copyediting and typesetting by our production team. After these production processes are complete and the authors have approved the resulting proofs, the article will move to the latest issue of the ERJ online. Please open or download the PDF to view this article.
Conflict of interest: Dr. DURAND has nothing to disclose.
Conflict of interest: Dr. GUIDDIR has nothing to disclose.
Conflict of interest: Dr. Kyheng has nothing to disclose.
Conflict of interest: Dr. BLANC has nothing to disclose.
Conflict of interest: Dr. VIGNAUD has nothing to disclose.
Conflict of interest: Dr. EPAUD has nothing to disclose.
Conflict of interest: Dr. DUGELAY has nothing to disclose.
Conflict of interest: Dr. BREANT has nothing to disclose.
Conflict of interest: Dr. BADIER has nothing to disclose.
Conflict of interest: Dr. DEGAS BUSSIERE has nothing to disclose.
Conflict of interest: Dr. PHAN has nothing to disclose.
Conflict of interest: Dr. SOUSSAN BANINI has nothing to disclose.
Conflict of interest: Dr. LEHNERT has nothing to disclose.
Conflict of interest: Dr. MBAMBA has nothing to disclose.
Conflict of interest: Dr. BARREY has nothing to disclose.
Conflict of interest: Dr. TAHIRI has nothing to disclose.
Conflict of interest: Dr. DECOBERT has nothing to disclose.
Conflict of interest: Dr. SAUNIER PERNAUDET has nothing to disclose.
Conflict of interest: Dr. CRAIU has nothing to disclose.
Conflict of interest: Dr. TAVEIRA has nothing to disclose.
Conflict of interest: Dr. GAJDOS has nothing to disclose.
- Received October 3, 2019.
- Accepted March 23, 2020.
- Copyright ©ERS 2020
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