Department of Neonatal Medicine and Pediatric Intensive Care, Arnaud de Villeneuve University Hospital, 371 Avenue Doyen G Giraud, 34295, Montpellier Cedex 5, France.
Pediatric Intensive Care Unit, Kremlin Bicêtre University Hospital, Paris, France.
Intensive Care Med. 2018 Nov;44(11):1870-1878. doi: 10.1007/s00134-018-5343-1. Epub 2018 Oct 21.
High-flow nasal cannula (HFNC) therapy is increasingly proposed as first-line respiratory support for infants with acute viral bronchiolitis (AVB). Most teams use 2 L/kg/min, but no study compared different flow rates in this setting. We hypothesized that 3 L/kg/min would be more efficient for the initial management of these patients.
A randomized controlled trial was performed in 16 pediatric intensive care units (PICUs) to compare these two flow rates in infants up to 6 months old with moderate to severe AVB and treated with HFNC. The primary endpoint was the percentage of failure within 48 h of randomization, using prespecified criteria of worsening respiratory distress and discomfort.
From November 2016 to March 2017, 142 infants were allocated to the 2-L/kg/min (2L) flow rate and 144 to the 3-L/kg/min (3L) flow rate. Failure rate was comparable between groups: 38.7% (2L) vs. 38.9% (3L; p = 0.98). Worsening respiratory distress was the most common cause of failure in both groups: 49% (2L) vs. 39% (3L; p = 0.45). In the 3L group, discomfort was more frequent (43% vs. 16%, p = 0.002) and PICU stays were longer (6.4 vs. 5.3 days, p = 0.048). The intubation rates [2.8% (2L) vs. 6.9% (3L), p = 0.17] and durations of invasive [0.2 (2L) vs. 0.5 (3L) days, p = 0.10] and noninvasive [1.4 (2L) vs. 1.6 (3L) days, p = 0.97] ventilation were comparable. No patient had air leak syndrome or died.
In young infants with AVB supported with HFNC, 3 L/kg/min did not reduce the risk of failure compared with 2 L/kg/min. This clinical trial was recorded on the National Library of Medicine registry (NCT02824744).
高流量鼻导管（HFNC）治疗越来越被提议作为急性病毒性细支气管炎（AVB）婴儿的一线呼吸支持。大多数团队使用 2 L/kg/min，但没有研究比较在这种情况下的不同流速。我们假设 3 L/kg/min 对这些患者的初始管理更有效。
在 16 个儿科重症监护病房（PICU）中进行了一项随机对照试验，以比较这两种流速在 6 个月以下、接受 HFNC 治疗的中重度 AVB 婴儿中的应用。主要终点是在随机分组后 48 小时内的失败率，使用预先指定的呼吸窘迫和不适加重的标准。
2016 年 11 月至 2017 年 3 月，142 名婴儿被分配到 2 L/kg/min（2L）流速组和 144 名婴儿被分配到 3 L/kg/min（3L）流速组。两组的失败率相似：38.7%（2L）与 38.9%（3L）（p=0.98）。在两组中，呼吸窘迫恶化都是失败的最常见原因：49%（2L）与 39%（3L）（p=0.45）。在 3L 组中，不适更常见（43%比 16%，p=0.002），PICU 住院时间更长（6.4 比 5.3 天，p=0.048）。插管率[2.8%（2L）与 6.9%（3L），p=0.17]和有创[0.2 天（2L）与 0.5 天（3L），p=0.10]和无创[1.4 天（2L）与 1.6 天（3L），p=0.97]通气的持续时间相当。没有患者发生气胸综合征或死亡。
在接受 HFNC 支持的 AVB 婴儿中，与 2 L/kg/min 相比，3 L/kg/min 并不能降低失败的风险。本临床试验已在国家医学图书馆注册（NCT02824744）。
