‘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

Abstract

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.

High‐flow Therapy for Bronchiolitis

“…One of the most commonly used fungi in probiotics is S. boulardi which is a S. cerevisiae strain. 1 Saccharomyces cerevisiae is an ubiquitus ascomycetous that commonly colonises the mucosal surfaces and is a part of the normal flora of the gastrointestinal and respiratory tract. As a probiotic component, this fungus may cause systemic infection in the immunocompromised adults and children.…”

“…We read with interest the paper on high-flow therapy for bronchiolitis. 1 The treatment of bronchiolitis has always been controversial. High-flow nasal cannula (HFNC) is increasingly popular to treat acute respiratory failure, especially bronchiolitis.…”

“…Hypertriglyceridaemia is commonly associated with hypothyroidism, nephrotic syndrome, diabetes mellitus and familial causes in children. 1 Uncommonly, lipid abnormalities have been detected in some haematological disorders including sickle cell disease, glucose-6-phosphate dehydrogenase deficiency, thalassaemia, spherocytosis, aplastic anaemia and myeodysplastic syndrome. 1 Here we report a case of hypertriglyceridaemia associated with beta thalassaemia major in a 6-month-old infant girl.…”

Letter to the Editor

“…We read with interest Tannous et al 'Safety and effectiveness of stoss therapy in children with vitamin D deficiency'. 1 The aims of randomisation are to minimise bias and confounding factors, produce comparable groups and enable probability theory to identify the risk of outcomes being due to chance alone. 2 Random number tables were used to assign treatment groups by family.…”

High‐flow oxygen therapy: Conclusion after adventures in the jungle of abbreviations

“…Thus, we do not exactly know which bronchiolitis patients should be treated with high‐flow oxygen therapy and which protocols should be used. The Paediatric Research in Emergency Departments International Collaborative Network, Australasia, recently recommended, in this journal, that high‐flow oxygen therapy may be used as a rescue treatment for hypoxaemic infants with bronchiolitis if they do not respond to standard oxygen …”