Bronchiolitis
Conditions
Keywords
Bronchiolitis, High, Flow, Oxygen, Therapy, Nasal, Cannulae, Prongs
Brief summary
Bronchiolitis is a common illness of the respiratory tract caused by infection of the tiny airways within the lungs called bronchioles. At present the standard care of hospitalized children with bronchiolitis is oxygen via nasal prongs. In this study the investigators would like to compare standard ward management with a new method of delivering oxygen called high flow nasal cannula oxygen therapy (HFNOT). HFNOT involves breathing warmed, moistened oxygen through nasal cannulae at a flow rate of 8 liters/minute. Accumulated experience suggests that HFNOT eases the child's work of breathing and reduces need for ICU admission and invasive respiratory support.
Detailed description
We propose a prospective open randomised controlled trial to compare high flow nasal cannula oxygen therapy (HFNOT) with standard oxygen therapy for infants hospitalised with bronchiolitis. This study will be the first of its kind, as currently there is no evidence in the published literature. All children will be cared for by the same medical team on two wards. All aspects of care other than oxygen delivery will not be specified, and be at the discretion of the physicians. HFNOT will not be used as an escalation of care on the wards. Randomisation will be performed by REDcap, in blocks of 6 patients. Patients will be identified in Emergency, informed consent obtained, and treatment started prior to transfer to the ward. For patients randomised to HFNOT, the flow rate will be fixed at 8 liters/minute, and the inspired oxygen concentration titrated to maintain saturations above 92%. Interim statistical analysis will be conducted to determine any positive or negative effect of HFNOT therapy. The first interval analysis will be performed after 50 subjects, the second after 100 subjects. If an effect is found, the study will be terminated following discussion with the hospital statistician and ethics board. Whichever treatment arm is found to be beneficial will be instituted as standard care for children with bronchiolitis.
Interventions
Warm humidified oxygen will be delivered at 8 liters/minute via nasal cannulae, at a concentration that maintains saturations greater than 92%.
OTHERStandard low flow oxygen
Standard low flow oxygen will be given to patients to maintain saturations greater than 92%.
Sponsors
University of British Columbia
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
No minimum to 18 Months
Healthy volunteers
No
Inclusion criteria
* All children under 18 months of age with a clinical diagnosis of bronchiolitis requiring admission to hospital for observation and oxygen.
Exclusion criteria
* Infants admitted directly to ICU from Emergency. * Prior positive pressure home ventilation. * Tracheostomy. * Nasogastric tubes in situ on admission. * Upper airway abnormality. * Congenital heart disease.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Length of hospital stay | Expected average length of stay 5 days | Number of hours that the patient remains in hospital. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Admission to Intensive Care Unit | During hospitalisation for bronchiolitis, expected average 5 days | Yes or No |
| Work of breathing | During hospital stay, expected average 5 days | Work of breathing, assessed by respiratory rate, at four timepoints on day one, and daily thereafter |
Countries
Canada
Outcome results
None listed