A randomised trial of high-flow nasal cannula in infants with moderate bronchiolitis

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 RCT, we assigned infants younger than 6 months who had moderate bronchiolitis to receive either HFNC at 3 L·kg⁻¹·min⁻¹ or standard oxygen therapy. Cross-over was not allowed. The primary outcome was the proportion of patient in treatment failure requiring escalation of care (mostly non-invasive ventilation) within 7-days following randomisation. Secondary outcome included rates of transfer in PICU, oxygen and nutritional-support length of days and adverse events. Results The analyses included 268 patients among the 2621 infants assessed for inclusion during 2 consecutive seasons in 17 French pediatric emergency departments. The percentage of infants in treatment failure was 14% (19 of 133) in the study group, compared to 20% (27 of 135) in the control group (OR 0.66; CI 95% 0.35–1.26, p=0.21). HFNC did not reduce the risk of admission in PICU (21 of 133 in the study group (15%) versus 26 of 135 in the control group (19%))(OR 0.78; CI 95% 0.41–1.41, p=.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 favor 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.