Philippe Durand1, Tamma Guiddir1, Christèle Kyheng1, Florence Blanc2, Olivier Vignaud3, Ralph Epaud4, Frédéric Dugelay4, Isabelle Breant5, Isabelle Badier6, Vanessa Degas-Bussière7, Florence Phan8, Valérie Soussan-Banini9, Agnès Lehnert10, Célestin Mbamba11, Catherine Barrey12, Cédric Tahiri13, Marion Decobert14, Marie Saunier-Pernaudet15, Irina Craiu1, Mélanie Taveira16, Vincent Gajdos. 1. Pediatric Emergency Dept, Bicêtre University Hospital, Assistance Publique-Hôpitaux de Paris, Kremlin-Bicêtre, France. 2. Villeneuve-Saint Georges Intercommunal Hospital, Villeneuve-Saint Georges, France. 3. Meaux Hospital, Meaux, France. 4. Créteil Intercommunal Hospital, Créteil, France. 5. Melun Hospital, Melun, France. 6. Poissy Hospital, Poissy, France. 7. Sud-Francilien Hospital, Corbeil-Essonnes, France. 8. Chartres Hospital, Chartres, France. 9. Ambroise Paré University Hospital, Assistance Publique-Hôpitaux de Paris, Boulogne-Billancourt, France. 10. Montargis Hospital, Amilly, France. 11. Gien Hospital, Gien, France. 12. Bry sur Marne Hospital, Bry sur Marne, France. 13. Dourdan Hospital, Dourdan, France. 14. Orsay Hospital, Orsay, France. 15. Fontainebleau Hospital, Fontainebleau, France. 16. Antoine Béclère University Hospital, Assistance Publique-Hôpitaux de Paris, Clamart, France.
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 randomised controlled trial, we assigned infants aged <6 months who had moderate bronchiolitis to receive either HFNC at 3 L·kg-1·min-1 or standard oxygen therapy. Crossover was not allowed. The primary outcome was the proportion of patients in treatment failure requiring escalation of care (mostly noninvasive ventilation) within 7 days following randomisation. Secondary outcomes included rates of transfer to the paediatric intensive care unit (PICU), oxygen, number of artificial nutritional support-free days and adverse events. RESULTS: The analyses included 268 patients among the 2621 infants assessed for inclusion during two consecutive seasons in 17 French paediatric emergency departments. The percentage of infants in treatment failure was 14% (19 out of 133) in the study group, compared to 20% (27 out of 135) in the control group (OR 0.66, 95% CI 0.35-1.26; p=0.21). HFNC did not reduce the risk of admission to PICU (21 (15%) out of 133 in the study group versus 26 (19%) out of 135 in the control group) (OR 0.78, 95% CI 0.41-1.41; p=0.45). 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 favour of 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.
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 randomised controlled trial, we assigned infants aged <6 months who had moderate bronchiolitis to receive either HFNC at 3 L·kg-1·min-1 or standard oxygen therapy. Crossover was not allowed. The primary outcome was the proportion of patients in treatment failure requiring escalation of care (mostly noninvasive ventilation) within 7 days following randomisation. Secondary outcomes included rates of transfer to the paediatric intensive care unit (PICU), oxygen, number of artificial nutritional support-free days and adverse events. RESULTS: The analyses included 268 patients among the 2621 infants assessed for inclusion during two consecutive seasons in 17 French paediatric emergency departments. The percentage of infants in treatment failure was 14% (19 out of 133) in the study group, compared to 20% (27 out of 135) in the control group (OR 0.66, 95% CI 0.35-1.26; p=0.21). HFNC did not reduce the risk of admission to PICU (21 (15%) out of 133 in the study group versus 26 (19%) out of 135 in the control group) (OR 0.78, 95% CI 0.41-1.41; p=0.45). 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 favour of 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.
Authors: Jonathan H Pelletier; Alicia K Au; Dana Fuhrman; Robert S B Clark; Christopher Horvat Journal: Pediatrics Date: 2021-05-10 Impact factor: 9.703