Franz E Babl1,2,3,4, Donna Franklin1,5,6,7,8,9, Luregn J Schlapbach5,7,8,9, Ed Oakley1,2,3,4, Stuart Dalziel1,10,11, Jennifer A Whitty12, Jocelyn Neutze1,13, Jeremy Furyk1,14,15, Simon Craig1,16,17, John F Fraser5,7, Mark Jones18, Andreas Schibler5,6,7,9. 1. Paediatric Research in Emergency Departments International Collaborative (PREDICT), Melbourne, Victoria, Australia. 2. Emergency Department, Royal Children's Hospital, Melbourne, Victoria, Australia. 3. Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Victoria, Australia. 4. Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia. 5. Pediatric Critical Care Research Group, Queensland Children's Hospital and The University of Queensland, Brisbane, Queensland, Australia. 6. Mater Research Institute, The University of Queensland, Brisbane, Queensland, Australia. 7. School of Medicine, The University of Queensland, Brisbane, Queensland, Australia. 8. Critical Care Research Group, Adult Intensive Care Service, The Prince Charles Hospital, Brisbane, Queensland, Australia. 9. Department of Pediatrics, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland. 10. Children's Emergency Department, Starship Children's Hospital, Auckland, New Zealand. 11. Liggins Institute, University of Auckland, Auckland, New Zealand. 12. Health Economics Group, Norwich Medical School, University of East Anglia, Norwich, United Kingdom. 13. Emergency Department, KidzFirst Middlemore Hospital, Auckland, New Zealand. 14. College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia. 15. Emergency Department, The Townsville Hospital, Townsville, Queensland, Australia. 16. Department of Medicine, School of Clinical Sciences, Monash University, Melbourne, Victoria, Australia. 17. Paediatric Emergency Department, Monash Medical Centre, Monash Health, Melbourne, Victoria, Australia. 18. School of Public Health, The University of Queensland, Brisbane, Queensland, Australia.
Abstract
AIM: Nasal high-flow oxygen therapy is increasingly used in infants for supportive respiratory therapy in bronchiolitis. It is unclear whether enteral hydration is safe in children receiving high-flow. METHODS: We performed a planned secondary analysis of a multi-centre, randomised controlled trial of infants aged <12 months with bronchiolitis and an oxygen requirement. Children were assigned to treatment with either high-flow or standard-oxygen therapy with optional rescue high-flow. We assessed adverse events based on how children on high-flow were hydrated: intravenously (IV), via bolus or continuous nasogastric tube (NGT) or orally. RESULTS: A total of 505 patients on high-flow via primary study assignment (n = 408), primary treatment (n = 10) or as rescue therapy (n = 87) were assessed. While on high flow, 15 of 505 (3.0%) received only IV fluids, 360 (71.3%) received only enteral fluids and 93 (18.4%) received both IV and enteral fluids. The route was unknown in 37 (7.3%). Of the 453 high-flow infants hydrated enterally patients could receive one or more methods of hydration; 80 (15.8%) received NGT bolus, 217 (43.0%) NGT continuous, 118 (23.4%) both bolus and continuous, 32 (6.3%) received only oral hydration and 171 (33.9%) a mix of NGT and oral hydration. None of the patients receiving oral or NGT hydration on high-flow sustained pulmonary aspiration (0%; 95% confidence interval N/A); one patient had a pneumothorax (0.2%; 95% confidence interval 0.0-0.7%). CONCLUSIONS: The vast majority of children with hypoxic respiratory failure in bronchiolitis can be safely hydrated enterally during the period when they receive high-flow.
AIM: Nasal high-flow oxygen therapy is increasingly used in infants for supportive respiratory therapy in bronchiolitis. It is unclear whether enteral hydration is safe in children receiving high-flow. METHODS: We performed a planned secondary analysis of a multi-centre, randomised controlled trial of infants aged <12 months with bronchiolitis and an oxygen requirement. Children were assigned to treatment with either high-flow or standard-oxygen therapy with optional rescue high-flow. We assessed adverse events based on how children on high-flow were hydrated: intravenously (IV), via bolus or continuous nasogastric tube (NGT) or orally. RESULTS: A total of 505 patients on high-flow via primary study assignment (n = 408), primary treatment (n = 10) or as rescue therapy (n = 87) were assessed. While on high flow, 15 of 505 (3.0%) received only IV fluids, 360 (71.3%) received only enteral fluids and 93 (18.4%) received both IV and enteral fluids. The route was unknown in 37 (7.3%). Of the 453 high-flow infants hydrated enterally patients could receive one or more methods of hydration; 80 (15.8%) received NGT bolus, 217 (43.0%) NGT continuous, 118 (23.4%) both bolus and continuous, 32 (6.3%) received only oral hydration and 171 (33.9%) a mix of NGT and oral hydration. None of the patients receiving oral or NGT hydration on high-flow sustained pulmonary aspiration (0%; 95% confidence interval N/A); one patient had a pneumothorax (0.2%; 95% confidence interval 0.0-0.7%). CONCLUSIONS: The vast majority of children with hypoxic respiratory failure in bronchiolitis can be safely hydrated enterally during the period when they receive high-flow.