A randomized trial of high-flow oxygen therapy in infants with bronchiolitis

Donna Franklin, Franz E. Babl, Luregn J. Schlapbach, Ed Oakley, Simon Craig, Jocelyn Neutze, Jeremy Furyk, John F. Fraser, Mark Jones, Jennifer A. Whitty, Stuart R. Dalziel, Andreas Schibler

Research output: Contribution to journalArticle

  • 12 Citations

Abstract

BACKGROUND High-flow oxygen therapy through a nasal cannula has been increasingly used in infants with bronchiolitis, despite limited high-quality evidence of its efficacy. The efficacy of high-flow oxygen therapy through a nasal cannula in settings other than intensive care units (ICUs) is unclear. METHODS In this multicenter, randomized, controlled trial, we assigned infants younger than 12 months of age who had bronchiolitis and a need for supplemental oxygen therapy to receive either high-flow oxygen therapy (high-flow group) or standard oxygen therapy (standard-therapy group). Infants in the standard-therapy group could receive rescue high-flow oxygen therapy if their condition met criteria for treatment failure. The primary outcome was escalation of care due to treatment failure (defined as meeting =3 of 4 clinical criteria: persistent tachycardia, tachypnea, hypoxemia, and medical review triggered by a hospital early-warning tool). Secondary outcomes included duration of hospital stay, duration of oxygen therapy, and rates of transfer to a tertiary hospital, ICU admission, intubation, and adverse events. RESULTS The analyses included 1472 patients. The percentage of infants receiving escalation of care was 12% (87 of 739 infants) in the high-flow group, as compared with 23% (167 of 733) in the standard-therapy group (risk difference, -11 percentage points; 95% confidence interval, -15 to -7; P<0.001). No significant differences were observed in the duration of hospital stay or the duration of oxygen therapy. In each group, one case of pneumothorax (<1% of infants) occurred. Among the 167 infants in the standard-therapy group who had treatment failure, 102 (61%) had a response to high-flow rescue therapy. CONCLUSIONS Among infants with bronchiolitis who were treated outside an ICU, those who received high-flow oxygen therapy had significantly lower rates of escalation of care due to treatment failure than those in the group that received standard oxygen therapy.

LanguageEnglish
Pages1121-1131
Number of pages11
JournalNew England Journal of Medicine
Volume378
Issue number12
DOIs
Publication statusPublished - 22 Mar 2018
Externally publishedYes

Fingerprint

Bronchiolitis
Oxygen
Group Psychotherapy
Treatment Failure
Therapeutics
Intensive Care Units
Length of Stay
Tachypnea
Pneumothorax
Intubation
Tertiary Care Centers
Tachycardia
Randomized Controlled Trials
Confidence Intervals

Cite this

Franklin, D., Babl, F. E., Schlapbach, L. J., Oakley, E., Craig, S., Neutze, J., ... Schibler, A. (2018). A randomized trial of high-flow oxygen therapy in infants with bronchiolitis. New England Journal of Medicine, 378(12), 1121-1131. https://doi.org/10.1056/NEJMoa1714855
Franklin, Donna ; Babl, Franz E. ; Schlapbach, Luregn J. ; Oakley, Ed ; Craig, Simon ; Neutze, Jocelyn ; Furyk, Jeremy ; Fraser, John F. ; Jones, Mark ; Whitty, Jennifer A. ; Dalziel, Stuart R. ; Schibler, Andreas. / A randomized trial of high-flow oxygen therapy in infants with bronchiolitis. In: New England Journal of Medicine. 2018 ; Vol. 378, No. 12. pp. 1121-1131.
@article{62cfdc85672c4db3934e82b78b1d7be4,
title = "A randomized trial of high-flow oxygen therapy in infants with bronchiolitis",
abstract = "BACKGROUND High-flow oxygen therapy through a nasal cannula has been increasingly used in infants with bronchiolitis, despite limited high-quality evidence of its efficacy. The efficacy of high-flow oxygen therapy through a nasal cannula in settings other than intensive care units (ICUs) is unclear. METHODS In this multicenter, randomized, controlled trial, we assigned infants younger than 12 months of age who had bronchiolitis and a need for supplemental oxygen therapy to receive either high-flow oxygen therapy (high-flow group) or standard oxygen therapy (standard-therapy group). Infants in the standard-therapy group could receive rescue high-flow oxygen therapy if their condition met criteria for treatment failure. The primary outcome was escalation of care due to treatment failure (defined as meeting =3 of 4 clinical criteria: persistent tachycardia, tachypnea, hypoxemia, and medical review triggered by a hospital early-warning tool). Secondary outcomes included duration of hospital stay, duration of oxygen therapy, and rates of transfer to a tertiary hospital, ICU admission, intubation, and adverse events. RESULTS The analyses included 1472 patients. The percentage of infants receiving escalation of care was 12{\%} (87 of 739 infants) in the high-flow group, as compared with 23{\%} (167 of 733) in the standard-therapy group (risk difference, -11 percentage points; 95{\%} confidence interval, -15 to -7; P<0.001). No significant differences were observed in the duration of hospital stay or the duration of oxygen therapy. In each group, one case of pneumothorax (<1{\%} of infants) occurred. Among the 167 infants in the standard-therapy group who had treatment failure, 102 (61{\%}) had a response to high-flow rescue therapy. CONCLUSIONS Among infants with bronchiolitis who were treated outside an ICU, those who received high-flow oxygen therapy had significantly lower rates of escalation of care due to treatment failure than those in the group that received standard oxygen therapy.",
author = "Donna Franklin and Babl, {Franz E.} and Schlapbach, {Luregn J.} and Ed Oakley and Simon Craig and Jocelyn Neutze and Jeremy Furyk and Fraser, {John F.} and Mark Jones and Whitty, {Jennifer A.} and Dalziel, {Stuart R.} and Andreas Schibler",
year = "2018",
month = "3",
day = "22",
doi = "10.1056/NEJMoa1714855",
language = "English",
volume = "378",
pages = "1121--1131",
journal = "New England Journal of Medicine",
issn = "0028-4793",
publisher = "MASSACHUSETTS MEDICAL SOC",
number = "12",

}

Franklin, D, Babl, FE, Schlapbach, LJ, Oakley, E, Craig, S, Neutze, J, Furyk, J, Fraser, JF, Jones, M, Whitty, JA, Dalziel, SR & Schibler, A 2018, 'A randomized trial of high-flow oxygen therapy in infants with bronchiolitis' New England Journal of Medicine, vol. 378, no. 12, pp. 1121-1131. https://doi.org/10.1056/NEJMoa1714855

A randomized trial of high-flow oxygen therapy in infants with bronchiolitis. / Franklin, Donna; Babl, Franz E.; Schlapbach, Luregn J.; Oakley, Ed; Craig, Simon; Neutze, Jocelyn; Furyk, Jeremy; Fraser, John F.; Jones, Mark; Whitty, Jennifer A.; Dalziel, Stuart R.; Schibler, Andreas.

In: New England Journal of Medicine, Vol. 378, No. 12, 22.03.2018, p. 1121-1131.

Research output: Contribution to journalArticle

TY - JOUR

T1 - A randomized trial of high-flow oxygen therapy in infants with bronchiolitis

AU - Franklin, Donna

AU - Babl, Franz E.

AU - Schlapbach, Luregn J.

AU - Oakley, Ed

AU - Craig, Simon

AU - Neutze, Jocelyn

AU - Furyk, Jeremy

AU - Fraser, John F.

AU - Jones, Mark

AU - Whitty, Jennifer A.

AU - Dalziel, Stuart R.

AU - Schibler, Andreas

PY - 2018/3/22

Y1 - 2018/3/22

N2 - BACKGROUND High-flow oxygen therapy through a nasal cannula has been increasingly used in infants with bronchiolitis, despite limited high-quality evidence of its efficacy. The efficacy of high-flow oxygen therapy through a nasal cannula in settings other than intensive care units (ICUs) is unclear. METHODS In this multicenter, randomized, controlled trial, we assigned infants younger than 12 months of age who had bronchiolitis and a need for supplemental oxygen therapy to receive either high-flow oxygen therapy (high-flow group) or standard oxygen therapy (standard-therapy group). Infants in the standard-therapy group could receive rescue high-flow oxygen therapy if their condition met criteria for treatment failure. The primary outcome was escalation of care due to treatment failure (defined as meeting =3 of 4 clinical criteria: persistent tachycardia, tachypnea, hypoxemia, and medical review triggered by a hospital early-warning tool). Secondary outcomes included duration of hospital stay, duration of oxygen therapy, and rates of transfer to a tertiary hospital, ICU admission, intubation, and adverse events. RESULTS The analyses included 1472 patients. The percentage of infants receiving escalation of care was 12% (87 of 739 infants) in the high-flow group, as compared with 23% (167 of 733) in the standard-therapy group (risk difference, -11 percentage points; 95% confidence interval, -15 to -7; P<0.001). No significant differences were observed in the duration of hospital stay or the duration of oxygen therapy. In each group, one case of pneumothorax (<1% of infants) occurred. Among the 167 infants in the standard-therapy group who had treatment failure, 102 (61%) had a response to high-flow rescue therapy. CONCLUSIONS Among infants with bronchiolitis who were treated outside an ICU, those who received high-flow oxygen therapy had significantly lower rates of escalation of care due to treatment failure than those in the group that received standard oxygen therapy.

AB - BACKGROUND High-flow oxygen therapy through a nasal cannula has been increasingly used in infants with bronchiolitis, despite limited high-quality evidence of its efficacy. The efficacy of high-flow oxygen therapy through a nasal cannula in settings other than intensive care units (ICUs) is unclear. METHODS In this multicenter, randomized, controlled trial, we assigned infants younger than 12 months of age who had bronchiolitis and a need for supplemental oxygen therapy to receive either high-flow oxygen therapy (high-flow group) or standard oxygen therapy (standard-therapy group). Infants in the standard-therapy group could receive rescue high-flow oxygen therapy if their condition met criteria for treatment failure. The primary outcome was escalation of care due to treatment failure (defined as meeting =3 of 4 clinical criteria: persistent tachycardia, tachypnea, hypoxemia, and medical review triggered by a hospital early-warning tool). Secondary outcomes included duration of hospital stay, duration of oxygen therapy, and rates of transfer to a tertiary hospital, ICU admission, intubation, and adverse events. RESULTS The analyses included 1472 patients. The percentage of infants receiving escalation of care was 12% (87 of 739 infants) in the high-flow group, as compared with 23% (167 of 733) in the standard-therapy group (risk difference, -11 percentage points; 95% confidence interval, -15 to -7; P<0.001). No significant differences were observed in the duration of hospital stay or the duration of oxygen therapy. In each group, one case of pneumothorax (<1% of infants) occurred. Among the 167 infants in the standard-therapy group who had treatment failure, 102 (61%) had a response to high-flow rescue therapy. CONCLUSIONS Among infants with bronchiolitis who were treated outside an ICU, those who received high-flow oxygen therapy had significantly lower rates of escalation of care due to treatment failure than those in the group that received standard oxygen therapy.

UR - http://www.scopus.com/inward/record.url?scp=85044435835&partnerID=8YFLogxK

U2 - 10.1056/NEJMoa1714855

DO - 10.1056/NEJMoa1714855

M3 - Article

VL - 378

SP - 1121

EP - 1131

JO - New England Journal of Medicine

T2 - New England Journal of Medicine

JF - New England Journal of Medicine

SN - 0028-4793

IS - 12

ER -

Franklin D, Babl FE, Schlapbach LJ, Oakley E, Craig S, Neutze J et al. A randomized trial of high-flow oxygen therapy in infants with bronchiolitis. New England Journal of Medicine. 2018 Mar 22;378(12):1121-1131. https://doi.org/10.1056/NEJMoa1714855