Franklin Donna, Babl Franz E, Gibbons Kristen, Pham Trang M T, Hasan Nadia, Schlapbach Luregn J, Oakley Ed, Craig Simon, Furyk Jeremy, Neutze Jocelyn, Moloney Susan, Gavranich John, Shirkhedkar Prasanna, Kapoor Vishal, Grew Simon, Fraser John F, Dalziel Stuart, Schibler Andreas
Paediatric Critical Care Research Group, Queensland Children's Hospital, The University of Queensland, Brisbane, QLD, Australia.
School of Medicine, The University of Queensland, Brisbane, QLD, Australia.
Front Pediatr. 2019 Oct 25;7:426. doi: 10.3389/fped.2019.00426. eCollection 2019.
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. 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 multicenter randomized controlled trial. 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 FiO 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. 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. In a small sub-group of hypoxemic infants with bronchiolitis hypoxemia can be reversed with the application of high-flow in room air only. ACTRN12615001305516.
细支气管炎是婴儿住院最常见的原因，三分之一的患儿因低氧血症需要吸氧治疗。目前尚不清楚患细支气管炎的低氧血症婴儿中，有多大比例可以在室内空气中使用鼻高流量吸氧治疗及其治疗效果。在最近一项多中心随机对照试验中，为评估室内空气中鼻高流量吸氧对分配至高流量治疗组的细支气管炎婴儿亚组的治疗效果。如果饱和度≥85%，分配至试验高流量组的婴儿最初接受室内空气高流量吸氧治疗。随后，如果氧饱和度未升至≥92%，则添加氧气并滴定FiO以提高氧饱和度。在这项计划中的亚研究中，将仅在整个住院期间接受室内空气高流量吸氧治疗的婴儿与接受标准吸氧或高流量吸氧治疗的婴儿进行比较。比较了基线特征、住院时间和吸氧治疗时间。在符合方案分析中，630名开始接受室内空气高流量吸氧治疗的婴儿中有64名（10%）在整个住院期间仅接受室内空气吸氧治疗。这些接受室内空气高流量吸氧治疗的婴儿平均年龄较大，入院时表现为中度低氧血症。他们的呼吸支持时间和住院时间也明显较短。在多变量分析中未发现预入选因素。在一小部分患细支气管炎的低氧血症婴儿中，仅通过在室内空气中应用高流量吸氧即可纠正低氧血症。澳大利亚新西兰临床试验注册号：ACTRN12615001305516。
