High flow in children with respiratory failure: A randomised controlled pilot trial - A paediatric acute respiratory intervention study.
acute respiratory failure
oxygen saturation
paediatrics
reactive airways disease
respiratory distress
Journal
Journal of paediatrics and child health
ISSN: 1440-1754
Titre abrégé: J Paediatr Child Health
Pays: Australia
ID NLM: 9005421
Informations de publication
Date de publication:
Feb 2021
Feb 2021
Historique:
received:
16
08
2020
revised:
07
10
2020
accepted:
24
10
2020
pubmed:
31
12
2020
medline:
15
5
2021
entrez:
30
12
2020
Statut:
ppublish
Résumé
High-flow is increasingly used in children with acute hypoxaemic respiratory failure (AHRF), despite limited evidence. The primary feasibility endpoint for this pilot-study was the proportion of treatment failure, secondary outcomes being intensive care unit (ICU) admissions and proportion of patients requiring escalation of care. We measured duration of hospital stay, duration of oxygen therapy and rates of ICU admission. An open-labelled randomised controlled trial feasibility design was used in two tertiary children's hospitals in the emergency department and general wards. Children aged 0-16 years with AHRF were randomised (1:1) to either high-flow or standard-oxygen. Children on standard-oxygen received rescue high-flow in general wards if failure criteria were met. Of 563 randomised, 283 received high-flow and 280 standard-oxygen with no adverse events. The proportion of children who failed treatment and receiving escalation of care was 11.7% (32/283 children) on high-flow and 18.1% (50/280 infants) on standard-oxygen (odds ratio 0.68, 95% confidence interval 0.38-1.00). In children with obstructive airway disease, 9.7% on high-flow and 17.4% on standard-oxygen required escalation (risk-difference -7.7% percentage points; 95% confidence interval -14.3, -1.1); in children with non-obstructive disease no difference was observed. Neither difference in ICU admissions nor any difference in length of hospital stay was observed. Sixty percent of children who failed standard-oxygen responded to rescue high-flow. High-flow outside ICU appears to be feasible in children with AHRF and the required proportion of escalation was lower compared to standard-oxygen. The trial design can be applied in a future large randomised controlled trial.
Substances chimiques
Oxygen
S88TT14065
Types de publication
Journal Article
Randomized Controlled Trial
Langues
eng
Sous-ensembles de citation
IM
Pagination
273-281Subventions
Organisme : Children's Health Foundation, Brisbane, Queensland
Organisme : Emergency Medicine Foundation
Organisme : National Health and Medical Research Council
Organisme : Thrasher Research Fund
Informations de copyright
© 2020 Paediatrics and Child Health Division (The Royal Australasian College of Physicians).
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