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A randomized clinical trial compared the efficiency of high-flow nasal cannula (HFNC) therapy with noninvasive ventilation (NIV) in treating pediatrics (under 2 years of age) diagnosed with bronchiolitis who developed respiratory distress.
High-flow nasal cannula therapy is non-inferior to noninvasive ventilation in infants with bronchiolitis experiencing mild to moderate respiratory distress, while also offering benefits such as shorter mechanical ventilation duration, reduced hospital stay, and lower sedative use.
A randomized clinical trial compared the efficiency of high-flow nasal cannula (HFNC) therapy with noninvasive ventilation (NIV) in treating pediatrics (under 2 years of age) diagnosed with bronchiolitis who developed respiratory distress.
Children with no chronic conditions who were hospitalized for bronchiolitis and advanced to respiratory distress (Wood-Downes-Férres score <8) were enrolled. Volunteers were randomized to get either HFNC or NIV (bilevel positive air pressure [BiPAP]) via a sealed envelope. In this noninferiority, open-label, single-center study, the measurements of vital signs, fraction of inspired oxygen (FiO2), Wood-Downes-Férres score, and HFNC/NIV parameters were taken for up to 96 hours following therapy onset.
Those who developed impaired respiration despite initial therapy were intubated, and crossover was not permitted. The requirement for invasive mechanical ventilation was the key outcome ascertained. Secondary endpoints encompassed mortality rate, sedation usage, duration of invasive mechanical ventilation, and length of stay (pediatric intensive care unit [PICU] and hospital).
Overall, 126 children were allocated to each group (NIV: 126 out of 132 randomized, 6 excluded; HFNC: 126 out of 136 randomized, 10 excluded). The median age was 2.5 months for the NIV group and 3 months for the HFNC group. The most common virus reported in both groups was respiratory syncytial virus (RSV; 72% for NIV vs. 71.4% for HFNC).
Notably, 37 kids in the NIV group and 29 kids in the HFNC group required intubation (29% vs. 23%). With a noninferiority margin of 15%, the Farrington-Manning test depicted a 6.3% difference supportive of HFNC. No prominent differences were reported in PICU length of stay or sedation duration. However, the HFNC group exhibited lower sedation requirements, shorter hospital length of stay, and reduced duration of invasive mechanical ventilation.
In children diagnosed with acute respiratory failure due to bronchiolitis, HFNC therapy was non-inferior to NIV.
BMC Pediatrics
Comparison between high-flow nasal cannula (HFNC) therapy and noninvasive ventilation (NIV) in children with acute respiratory failure by bronchiolitis: a randomized controlled trial
Ana Carolina Etrusco Zaroni Santos et al.
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