Design and main outcomes of the largest three randomised controlled trials (RCTs) comparing high-flow nasal cannula (HFNC) therapy versus standard care for infants with moderate bronchiolitis on the paediatric ward
| Franklin et al. [7] | Kepreotes et al. [8] | Durand et al. [9] | |
| Design | Multicentre RCT Age <12 months n=1472 (739/733) SpO2 goal ≥92% or ≥94% | Single-centre RCT Age <24 months n=202 (101/101) SpO2 goal ≥94% | Multicentre RCT Age <6 months n=268 (133/135) SpO2 goal ≥94% |
| Intervention | HFNC 2 L·kg−1·min−1 versus standard care (O2 ≤2 L·min−1) Rescue HFNC allowed | HFNC <1 L·kg−1·min−1 versus standard care (O2 <2 L·min−1) Rescue HFNC allowed | HFNC 3 L·kg−1·min−1 versus standard care (O2 <2 L·min−1) No crossover |
| Primary outcome | Escalation of care due to treatment failure | Time from randomisation to last use of oxygen | Escalation of care due to treatment failure |
| Short-term outcomes | |||
| Escalation of care/treatment failure | 12% versus 23%; p<0.001 | 14% versus 33%; p<0.002 | 14% versus 20%; p=0.21 |
| Rescue by HFNC in standard care group | 61% | 63% | No crossover allowed |
| Comfort/feeding score | Favours HFNC | ||
| Clinical score | Favours HFNC | ||
| Respiratory rate | Favours standard care | Favours HFNC | Favours HFNC |
| Adverse events | 1 pneumothorax in both groups | None significant | 3 pneumothoraces in HFNC |
| Long-term outcomes | |||
| Admission to PICU | No difference (10.5%) | No difference (∼13%) | No difference (13%) |
| Transfer to PICU in another hospital | No difference | No difference | |
| Duration of stay in PICU | No difference | ||
| Endotracheal ventilation | No difference (∼1%) | None | |
| Days of O2 supplementation | No difference | No difference | Favours HFNC |
| Length of stay | No difference | No difference | No difference |
| Conclusions | Significantly lower rates of escalation of care due to treatment failure | HFNC did not reduce time of oxygen supplementation | No difference in escalation of respiratory support |