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EARLY NASAL HIGH-FLOW FOR CHILDREN WITH ACUTE HYPOXAEMIC RESPIRATORY FAILURE: A RANDOMISED CONTROLLED TRIAL.
- Andreas Schibler (Australia)
Abstract
Background and Aims
Nasal high-flow therapy in hypoxic infants with bronchiolitis has been shown to reduce the requirement to escalate care. The efficacy of high-flow in children with acute hypoxaemic respiratory failure outside bronchiolitis is unknown.
Methods
Children aged 1-4 years of age with acute hypoxaemic respiratory failure in 14 Australian and New Zealand emergency departments were randomly assigned (1:1) to receive either nasal high-flow (NHF) or standard-oxygen therapy (SOT). The oxygen therapy could not be masked for obvious reasons, but the investigators remained blinded until outcome data was locked. Primary outcome was length of hospital stay. Secondary outcomes included length of oxygen therapy and intensive care admission. Analyses were performed on an intention-to-treat (ITT) population. Recruitment is closed and the study registered with anzctr.org.au, ACTRN12618000210279.
Results
Commencing Dec 18, 2017, to 22 March 2020 1,567 children (n=753 NHF, n=764 SOT) were enrolled at 14 sites and included in the ITT analysis. Length of hospital stay was significantly longer in the NHF group with a median of 1·77 days (interquartile range [IQR], 1·03 to 2·80) versus 1·50 days (IQR 0·85 to 2·44) in the SOT group (adjusted hazards ratio [aHR] 0·83 (95% confidence interval [CI], 0·75 to 0·92; P<0·001)· Length of oxygen therapy was significantly longer in the NHF group with a median of 1·07 days (IQR, 0·50 to 2·06) versus 0·75 days (IQR, 0·35 to 1·61) in the SOT group (aHR 0·78; 95% CI, 0·70 to 0·86). Greater ICU admissions occurred in the NHF group (n=94, 12·5%) compared to the SOT group (n=53, 6·9%; give effect estimate, 95% CI and p value).
Conclusions
NHF used as the initial primary oxygen therapy in children with acute hypoxaemic respiratory failure and aged 1-4 years did prolong length of hospital stay compared to SOT.