High-flow warm humidified oxygen versus standard low-flow nasal cannula oxygen for moderate bronchiolitis (HFWHO RCT): an open, phase 4, randomised controlled trial

Kepreotes, Elizabeth; Whitehead, Bruce; Attia, John; Oldmeadow, Christopher; Collison, Adam; Searles, Andrew; Goddard, Bernadette; Hilton, Jodi; Lee, Mark; Mattes, Joërg

doi:10.1016/s0140-6736(17)30061-2

Cited by 258 publications

(378 citation statements)

References 21 publications

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“…There was no evidence of a shorter duration of oxygen therapy, lower rate of ICU admission, or shorter duration of hospital stay in infants receiving high-flow oxygen therapy than in those receiving standard subnasal oxygen therapy. Our findings are supported by the results of a recent smaller trial, 21 which showed a similar effect size, with a lower treatment-failure rate in the high-flow group than in the standard-therapy group (14% vs. 33%). No significant differences in the duration of oxygen therapy and the duration of hospital stay were found in that trial.…”

Section: Discussionsupporting

confidence: 89%

A Randomized Trial of High-Flow Oxygen Therapy in Infants with Bronchiolitis

et al. 2018

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BACKGROUNDHigh-flow oxygen therapy through a nasal cannula has been increasingly used in infants with bronchiolitis, despite limited high-quality evidence of its efficacy. The efficacy of high-flow oxygen therapy through a nasal cannula in settings other than intensive care units (ICUs) is unclear. METHODSIn this multicenter, randomized, controlled trial, we assigned infants younger than 12 months of age who had bronchiolitis and a need for supplemental oxygen therapy to receive either high-flow oxygen therapy (high-flow group) or standard oxygen therapy (standard-therapy group). Infants in the standard-therapy group could receive rescue high-flow oxygen therapy if their condition met criteria for treatment failure. The primary outcome was escalation of care due to treatment failure (defined as meeting ≥3 of 4 clinical criteria: persistent tachycardia, tachypnea, hypoxemia, and medical review triggered by a hospital early-warning tool). Secondary outcomes included duration of hospital stay, duration of oxygen therapy, and rates of transfer to a tertiary hospital, ICU admission, intubation, and adverse events. RESULTSThe analyses included 1472 patients. The percentage of infants receiving escalation of care was 12% (87 of 739 infants) in the high-flow group, as compared with 23% (167 of 733) in the standard-therapy group (risk difference, −11 percentage points; 95% confidence interval, −15 to −7; P<0.001). No significant differences were observed in the duration of hospital stay or the duration of oxygen therapy. In each group, one case of pneumothorax (<1% of infants) occurred. Among the 167 infants in the standard-therapy group who had treatment failure, 102 (61%) had a response to high-flow rescue therapy. CONCLUSIONSAmong infants with bronchiolitis who were treated outside an ICU, those who received high-flow oxygen therapy had significantly lower rates of escalation of care due to treatment failure than those in the group that received standard oxygen therapy. Original ArticleThe New England Journal of Medicine 1122T h e ne w e ngl a nd jou r na l o f m e dicine B ronchiolitis, an acute lower airway lung disease that is generally caused by respiratory viruses, is the most common reason worldwide for nonelective hospital admission in infants. In the United States, bronchiolitis is responsible for $1.7 billion in hospitalization costs annually.1,2 In Australia and New Zealand, there has been a population-based increase in admissions to the intensive care unit (ICU) for bronchiolitis, with associated increases in hospital costs. 3Numerous studies have investigated the role of medical therapies 4 in infants with bronchiolitis; none of these interventions have shown efficacy. 5The American Academy of Pediatrics guidelines recommend only supportive therapy that includes oxygen therapy for hypoxemia, respiratory support, and the maintenance of hydration. 5,6 Respiratory support as provided in emergency and ward settings has been limited to oxygen delivered through a standard nasal cannula, at a rate of up to 2 li...

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Section: Discussionsupporting

confidence: 89%

A Randomized Trial of High-Flow Oxygen Therapy in Infants with Bronchiolitis

et al. 2018

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“…The outcomes of our study support those of Kepreotes2 and Riese3 and prompt reflection: what are our actual treatment goals when using HFNC? Why has HFNC become so well established internationally without an adequate evidence base to guide appropriate use?…”

supporting

confidence: 79%

“…Current National Institute for Health and Care Excellence (NICE 2015) guidelines for bronchiolitis state that ‘the use of this medical device is becoming widespread without demonstration of additional efficacy’. Recent studies by Kepreotes et al 2 and Riese et al 3 have shown that the use of ward-based HFNC in children with bronchiolitis did not reduce the hospital length of stay (LOS) or rate of admission to the paediatric intensive care unit (PICU), when compared with standard low-flow oxygen therapy.…”

mentioning

confidence: 99%

Humidified high-flow nasal cannula oxygen for bronchiolitis: should we go with the flow?

et al. 2017

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“…As such, Guideline recommendations regarding the use of HFNC for bronchiolitis were as follows: (i) in non‐hypoxic infants, its use should be confined to randomised controlled trials (RCTs); and (ii) in hypoxic infants (oxygen saturations less than 92%), there is a low‐level recommendation (NHMRC: C, GRADE: Conditional) to consider HFNC. Subsequent to the 2015 systematic literature search for the Australasian bronchiolitis guidelines, a number of RCTs published their results, particularly three major studies . This paper updates the systematic literature review regarding HFNC use in bronchiolitis used for the Australian bronchiolitis guideline, summarises and critiques the new RCTs and provides evidence‐based recommendations for the use of HFNC to manage bronchiolitis in the ED and ward settings.…”

mentioning

confidence: 94%

‘Rational use of high‐flow therapy in infants with bronchiolitis. What do the latest trials tell us?’ A Paediatric Research in Emergency Departments International Collaborative perspective

O’Brien

Craig

Babl

et al. 2019

J Paediatrics Child Health

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Bronchiolitis is the most common reason for infants to be hospitalised. Over the past decade, the use of high‐flow nasal cannulae (HFNC) therapy has increased markedly and it is now utilised not only in the intensive care unit setting but in general paediatric wards and emergency departments. The aim of this systematic review was to summarise and critique the current evidence‐base for the use of HFNC in infants with bronchiolitis. We searched Ovid Medline, OvidEmbase, PubMed, Cinahl, Cochrane Library, Cochrane Database of Systematic Reviews and Cochrane Central Register of Controlled Trials for systematic reviews and randomised controlled trials of HFNC therapy in infants with bronchiolitis from 1 January 2000 to 27 June 2018. We identified four randomised controlled trials (n = 1891) of HFNC in infants with bronchiolitis: three of these studies involved infants treated in emergency departments and inpatient paediatric wards in Spain, Australia and New Zealand, and one study involved infants treated in paediatric intensive care units in France. The findings of this review suggest that HFNC should be used as a rescue treatment for hypoxaemic infants who have not responded to standard sub nasal oxygen therapy. The use of HFNC for work of breathing in the absence of hypoxaemia, and severe disease, is not currently supported by the evidence, and should only be considered in the context of an appropriate research trial.

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High-flow warm humidified oxygen versus standard low-flow nasal cannula oxygen for moderate bronchiolitis (HFWHO RCT): an open, phase 4, randomised controlled trial

Cited by 258 publications

References 21 publications

A Randomized Trial of High-Flow Oxygen Therapy in Infants with Bronchiolitis

A Randomized Trial of High-Flow Oxygen Therapy in Infants with Bronchiolitis

Humidified high-flow nasal cannula oxygen for bronchiolitis: should we go with the flow?

‘Rational use of high‐flow therapy in infants with bronchiolitis. What do the latest trials tell us?’ A Paediatric Research in Emergency Departments International Collaborative perspective

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