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Original Research ARTICLE Provisionally accepted The full-text will be published soon. Notify me

Front. Pediatr. | doi: 10.3389/fped.2019.00426

Nasal High Flow in Room Air for Hypoxemic Bronchiolitis Infants

 Donna Franklin1, 2, 3, 4, 5*, Franz E. Babl4, 6, 7, 8, Kristen Gibbons1, 3, Trang M. Pham1, 3, Nadia Hasan2,  Luregn J. Schlapbach1, 2, 3, Ed Oakley4, 6, 7, 8, Simon Craig4, 9, 10, Jeremy Furyk4, 11, 12, Jocelyn Neutze4, 13, 14, Susan Moloney15, 16, 17, John Gavranich18,  Prasanna Shirkhedkar19, Vishal Kapoor1, 2, Simon Grew20, John F. Fraser2, 5, Stuart R. Dalziel4, 21, 22 and  Andreas Schibler1, 2, 3, 4
  • 1Queensland Children's Hospital, Children's Health Queensland, Australia
  • 2University of Queensland, Australia
  • 3Mater Research Institute, University of Queensland, Australia
  • 4Paediatric Research in Emergency Departments International Collaborative, Australia
  • 5Critical Care Research Group (CCRG), Australia
  • 6Royal Children's Hospital, Australia
  • 7Murdoch Childrens Research Institute (MCRI), Australia
  • 8Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Australia
  • 9School of Clinical Sciences, Monash University, Australia
  • 10Monash Medical Centre, Australia
  • 11College of Medicine and Dentistry, James Cook University, Australia
  • 12Townsville Hospital, Australia
  • 13Kidz First Middlemore Hospital, New Zealand
  • 14The University of Auckland, New Zealand
  • 15Department of Paediatrics, Gold Coast University Hospital, Australia
  • 16School of Medicine, Griffith Health, Griffith University, Australia
  • 17Faculty of Health Sciences and Medicine, Bond University, Australia
  • 18Department of Paediatrics, Ipswich Hospital, Australia
  • 19Department of Paediatrics, Caboolture Hospital, Australia
  • 20Redcliffe Hospital, Australia
  • 21Childrens' Emergency Department, Starship Children's Health, New Zealand
  • 22Liggins Institute, University of Auckland, New Zealand

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 multicentre 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.

Keywords: Oxygen therapy, Room air, Bronchiolitis, respiratory illness, Nasal high flow therapy

Received: 02 May 2019; Accepted: 04 Oct 2019.

Copyright: © 2019 Franklin, Babl, Gibbons, Pham, Hasan, Schlapbach, Oakley, Craig, Furyk, Neutze, Moloney, Gavranich, Shirkhedkar, Kapoor, Grew, Fraser, Dalziel and Schibler. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: Mx. Donna Franklin, Queensland Children's Hospital, Children's Health Queensland, Brisbane, Australia, d.franklin2@uq.edu.au