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High-flow oxygen therapy reduces the need for escalation of care in infants with bronchiolitis

Elaine Soliven
20 Apr 2018

The use of high-flow oxygen therapy may reduce the need for escalation of care in infants with bronchiolitis compared with standard oxygen therapy, according to a recent study.

“High-flow oxygen therapy through a nasal cannula has emerged as a new method to provide respiratory support for respiratory diseases in neonates, infants, children, and adults,” according to the researchers.

“[The results] showed a higher rate of treatment success among infants treated with high-flow oxygen therapy than those who received standard oxygen therapy, … [as well as] confirmed a lower hazard of treatment failure in the high-flow group,” the researchers said.

Researchers gathered data from the emergency departments and general paediatric inpatient units at tertiary and regional hospitals in Australia and New Zealand and analysed 1,472 infants with bronchiolitis. Participants were randomized in a 1:1 ratio to receive high-flow oxygen therapy (n=739, mean age 5.76 months, 39 percent female) or standard oxygen therapy (n=733, mean age 6.10 months, 36 percent female). The study’s primary outcome was escalation of care due to treatment failure of bronchiolitis (ie, meeting ≥3 of the four clinical criteria: hypoxaemia, persistent tachycardia, tachypnoea, and medical review triggered by a hospital early-warning tool). [N Engl J Med 2018;doi:10.1056/NEJMoa1714855]

The overall rate of escalation of care (increase in respiratory support or transfer to an ICU) due to treatment failure was significantly lower among infants who received high-flow oxygen therapy compared with standard oxygen therapy (12 percent vs 23 percent, relative risk [RR], 0.52; p<0.001).

The lower rates of escalation of care among infants in the high-flow group was evident regardless of whether infants were treated at hospitals with an onsite ICU (14 percent vs 20 percent, RR, 0.71; p<0.001) or without (7 percent vs 28 percent, RR, 0.27; p<0.001).

A significantly higher respiratory rate was observed among infants on high-flow oxygen therapy compared with those on standard oxygen therapy (62.6 vs 54.6 beats per minute, odds ratio, 8.02; p<0.001).

Adverse event incidence was similar between groups, with only one event of pneumothorax in each group, with no serious adverse events.

Of the 167 infants with treatment failure who received standard oxygen therapy, 61 percent were crossed over to receive high-flow oxygen therapy as a rescue treatment.

“The rescue use of high-flow oxygen therapy reflected a real-world scenario, because high-flow therapy was used as standard practice in Australia and New Zealand at the time of our trial,” the researchers noted.

“[Furthermore,] observational and physiological studies suggest that decreased work of breathing, improved oxygenation, and reduced rates of intubation are associated with high-flow oxygen therapy,” said the researchers.
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Most Read Articles
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