Nasal High Flow in Room Air for Hypoxemic Bronchiolitis Infants

Donna Franklin; Franz E Babl; Kristen Gibbons; Trang M T Pham; Nadia Hasan; Luregn J Schlapbach; Ed Oakley; Simon Craig; Jeremy Furyk; Jocelyn Neutze; Susan Moloney; John Gavranich; Prasanna Shirkhedkar; Vishal Kapoor; Simon Grew; John F Fraser; Stuart Dalziel; Andreas Schibler; PARIS and PREDICT

doi:10.3389/fped.2019.00426

Nasal High Flow in Room Air for Hypoxemic Bronchiolitis Infants

Front Pediatr. 2019 Oct 25:7:426. doi: 10.3389/fped.2019.00426. eCollection 2019.

Authors

Donna Franklin^{1

2

3

4

5}, Franz E Babl^{5

6

7

8}, Kristen Gibbons^{1

3}, Trang M T Pham^{1

3}, Nadia Hasan², Luregn J Schlapbach^{1

2

3}, Ed Oakley^{5

6

7

8}, Simon Craig^{5

9

10}, Jeremy Furyk^{5

11

12}, Jocelyn Neutze^{5

13

14}, Susan Moloney^{15

16

17}, John Gavranich¹⁸, Prasanna Shirkhedkar¹⁹, Vishal Kapoor^{1

2}, Simon Grew²⁰, John F Fraser^{2

4}, Stuart Dalziel^{5

21

22}, Andreas Schibler^{1

2

3

5}; PARIS and PREDICT

Affiliations

¹ Paediatric Critical Care Research Group, Queensland Children's Hospital, The University of Queensland, Brisbane, QLD, Australia.
² School of Medicine, The University of Queensland, Brisbane, QLD, Australia.
³ Mater Research Institute, The University of Queensland, Brisbane, QLD, Australia.
⁴ Critical Care Research Group, Adult Intensive Care Service, The Prince Charles Hospital, Brisbane, QLD, Australia.
⁵ Paediatric Research in Emergency Departments International Collaborative (PREDICT), Parkville, VIC, Australia.
⁶ Royal Children's Hospital, Emergency Department, Melbourne, VIC, Australia.
⁷ Murdoch Children's Research Institute, Melbourne, VIC, Australia.
⁸ Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, VIC, Australia.
⁹ Department of Medicine, School of Clinical Sciences, Monash University, Clayton, VIC, Australia.
¹⁰ Monash Medical Centre, Emergency Department, Melbourne, VIC, Australia.
¹¹ College of Medicine and Dentistry, James Cook University, Townsville, QLD, Australia.
¹² The Townsville Hospital, Emergency Department, Townsville, QLD, Australia.
¹³ KidzFirst Middlemore Hospital, Auckland, New Zealand.
¹⁴ University of Auckland, Auckland, New Zealand.
¹⁵ Department of Paediatrics, Gold Coast University Hospital, Southport, QLD, Australia.
¹⁶ School of Medicine, Griffith University, Gold Coast, QLD, Australia.
¹⁷ Faculty of Health Sciences and Medicine, Bond University, Gold Coast, QLD, Australia.
¹⁸ Paediatric Department, Ipswich General Hospital, Ipswich, QLD, Australia.
¹⁹ Paediatric Department, Caboolture Hospital, Caboolture, QLD, Australia.
²⁰ Paediatric Department, Redcliffe Hospital, Redcliffe, QLD, Australia.
²¹ Children's Emergency Department, Starship Children's Hospital, Auckland, New Zealand.
²² Liggins Institute, University of Auckland, Auckland, New Zealand.

Abstract

Background: Bronchiolitis is the most common reason for hospital admission in infants, with one third requiring oxygen therapy due to hypoxemia. It is unknown what proportion of hypoxemic infants with bronchiolitis can be managed with nasal high-flow in room air and their resulting outcomes. Objectives and Settings: To assess the effect of nasal high-flow in room air in a subgroup of infants with bronchiolitis allocated to high-flow therapy in a recent multicenter randomized controlled trial. Patients and Interventions: Infants allocated to the high-flow arm of the trial were initially treated with room air high-flow if saturations were ≥85%. Subsequently, if oxygen saturations did not increase to ≥92%, oxygen was added and FiO₂ was titrated to increase the oxygen saturations. In this planned sub-study, infants treated during their entire hospital stay with high-flow room air only were compared to infants receiving either standard-oxygen or high-flow with oxygen. Baseline characteristics, hospital length of stay and length of oxygen therapy were compared. Findings: In the per protocol analysis 64 (10%) of 630 infants commenced on high-flow room air remained in room air only during the entire stay in hospital. These infants on high-flow room air were on average older and presented with moderate hypoxemia at presentation to hospital. Their length of respiratory support and length of stay was also significantly shorter. No pre-enrolment factors could be identified in a multivariable analysis. Conclusions: In a small sub-group of hypoxemic infants with bronchiolitis hypoxemia can be reversed with the application of high-flow in room air only. Trial registration: ACTRN12615001305516.

Keywords: bronchiolitis; nasal high flow therapy; oxygen therapy; respiratory illness; room air.