High-Flow Nasal Cannula Oxygen in Children with Bronchiolitis: A
Randomized Controlled Trial
Abstract
Objective: To determine whether high-flow nasal cannula oxygen (HFNCO)
provided enhanced respiratory support in bronchiolitis than low-flow
oxygen (LFO). Methods: We conducted a prospective, randomized controlled
trial in children between 1-24 months diagnosed with moderate-to-severe
bronchiolitis requiring oxygen therapy. Participants received LFO via
face mask (6-10 L/min) or HFNCO (2 L*kg/min). Primary outcomes were the
time that heart rate (HR) and respiratory rate (RR) return to their
normal range for age and the time that baseline clinical respiratory
score (CRS) regress to a lower severity score. Secondary outcomes were
changes in HR, RR, and CRS over time, length of stay (LOS), duration of
oxygen requirement, treatment failure, and adverse event (AE). Results:
Eighty-seven children were enrolled (48 in LFO; 39 in HFNCO). The time
that HR and RR baseline values reached their normal range for age was
shorter in HFNCO therapy (2.0h [1.0-4.0] vs. 12.0h [2.0-24.0]
and 4.0 h [2.0-12.0] vs. 24.0 h [4.0-48.0], respectively;
P< .001); additionally, the improvement in CRS emerged more
quickly in children treated with HFNCO (2.0 h [1.0-4.0] vs. 4.0 h
[2.0-24.0]; P = .003). While the duration of oxygen requirement
(19.0 h [4.0-30.0] vs. 29.5 h [14.0-45.7]; P = .009) and
treatment failure (3% vs. 21%) was statistically lower in children who
received HFNCO, there were no differences in LOS and AE between groups.
Conclusion: HFNCO may provide enhanced respiratory support with a
notable improvement in HR, RR, and CRS than LFO. Comprehensive studies
are needed to assess the clinical efficacy of HFNCO therapy.