High-flow better than standard oxygen therapy for treating infants with bronchiolitis

In the management of paediatric bronchiolitis, high-flow oxygen therapy appears to be superior to standard oxygen therapy in terms of rate of escalation of care due to treatment failure, according to the results of a trial.

A total of 1,472 infants aged <12 months who had bronchiolitis and required supplemental oxygen therapy were randomized to receive either high-flow oxygen therapy (high-flow group; n=739) or standard oxygen therapy (standard-therapy group; n=733). Infants in the standard-therapy group could receive rescue high-flow oxygen therapy in case of treatment failure.

The primary outcome was escalation of care due to treatment failure (defined as meeting ≥3 of 4 clinical criteria: persistent tachycardia, tachypnoea, hypoxemia and medical review triggered by a hospital early-warning tool). Duration of hospital stay, duration of oxygen therapy, rates of transfer to a tertiary hospital, ICU admission, intubation and adverse events were also assessed as secondary outcomes.

Significantly fewer patients in the high-flow vs standard-therapy group received escalation of care (12 percent vs 23 percent; risk difference, −11 percentage points; 95 percent CI, −15 to −7; p<0.001). On the other hand, duration of hospital stay and duration of oxygen therapy were similar between the two groups.

Pneumothorax occurred in one patient in each treatment group. Among 167 infants in the standard-therapy group who had treatment failure, 102 (61 percent) showed a response to high-flow rescue therapy.

Delivered through a nasal cannula, high-flow oxygen blends humidified and heated air with oxygen and provides a degree of positive airway pressure.