FRINK Linked Data Fragments server

Matches in SemOpenAlex for { <https://semopenalex.org/work/W2801591687> ?p ?o ?g. }

• W2801591687 endingPage "1307" @default.
• W2801591687 startingPage "1306" @default.
• W2801591687 abstract "High-flow oxygen therapy (HFOT) through a nasal cannula has been increasingly used, despite a lack of high-quality evidence on its effectiveness. Now, two large, prospective, randomised controlled trials (RCTs), published in 2017 1 and 2018 2, have shown that using HFOT with a warmed and humidified air-oxygen mixture is more effective than standard low-flow oxygen therapy with nonwarmed wall oxygen if infants with bronchiolitis need oxygen supplementation. A 3-year RCT by Kepreotes et al. 1 in one Australian hospital focused on 202 children who were admitted for bronchiolitis at <24 months of age and needed oxygen supplementation. The flow rate was 1 L/kg/minute (maximum 20 L/minute) in the HFOT group and a maximum of 2 L/minute in the standard therapy group. The main result of the study was that treatment failures were significantly less common in the HFOT group (14/101, 14%) compared to the standard treatment group (33/101, 33%, p = 0.002). The treatment failure was defined by critically abnormal findings, such as oxygen saturation of <90%, which required a rapid response within 10 minutes by the intensive care unit (ICU). The mean risk difference in treatment failures between the arms was 19 percentage points in favour of HFOT, which corresponds to a number needed to treat of 5.3 to prevent one failure. Furthermore, 61% (20/33) of the children with treatment failures in standard therapy were successfully rescued with HFOT. However, HFOT did not reduce the duration of oxygen support or the length of hospital stay. The authors had decided before the trial started that the time it took to wean the patients off oxygen was the primary outcome measure and the trial proved ineffective in this regard. However, the study demonstrated an improvement in another outcome, which was even more clinically important, and that was that treatment failure required a response from the ICU team. The effect size for this outcome was substantial. No serious adverse events occurred in either group. The authors stated that the results indicated that the early use of HFOT did not modify the overall course of infant bronchiolitis and that when HFOT was used as a rescue therapy on the ward it reduced the proportion of children requiring high-cost ICU care. However, they did not conclude that all infants with bronchiolitis who need oxygen supplementation should be routinely treated with HFOT instead of low-flow therapy 1, as the effect on the chosen primary outcome, the time to wean patients off oxygen, was not achieved. A 3-year RCT in Australia and New Zealand by Franklin et al. 2, 3 was carried out in five tertiary hospitals and 12 regional secondary hospitals with or without paediatric ICUs. The study comprised 1472 infants who were admitted for bronchiolitis at <12 months of age and who needed oxygen supplementation. The flow rate was 2 L/kg/minute (maximum 25 L/minute) in the HFOT group and a maximum of 2 L/minute in the standard therapy group. The primary outcome was the escalation of care due to treatment failures, specified by a combination of unfavourable changes in heart rate, respiratory rate and fraction of inspired oxygen. The main result of the study was that treatment failures were significantly less common in the HFOT group (87/739, 12%) than the standard treatment group (167/733, 23%, p < 0.001). The mean risk difference in treatment failures between the arms was 11 percentage points in favour of HFOT, which corresponded to a number needed to treat of 9.1 to prevent one failure. Again, 61% (102/167) of the children with treatment failure in the standard therapy group were successfully rescued with HFOT, and HFOT did not reduce the duration of oxygen support or the length of hospital stay. In each group, one case of pneumothorax, affecting <1% of the infants, occurred. In the conclusions, the authors highlighted the reduced rate of treatment failures and escalations of care when HFOT was used early, compared to standard oxygen therapy, but they did not provide any clinical recommendations 2. The findings in the Australian and New Zealand RCT that HFOT was not associated with a lower rate of admissions to the ICU need more discussion 2. The rate of ICU admissions was 12% in the HFOT group and only 9% in the standard treatment group after rescue therapy with HFOT on the ward (odds ratio 1.37, 95% confidence interval 0.96–1.95). At the time when care was escalated, the mean respiratory rate was higher in the HFOT group than in the standard treatment group, which suggests that treatment failures were diagnosed later in the course of bronchiolitis if the patient was treated with HFOT. Thus, if the chosen outcome measure is the transfer to the ICU, standard oxygen administration supplemented with HFOT, if required, may be an equally beneficial way to treat infants with bronchiolitis who need oxygen supplementation than early HFOT. As the trial was unblinded for the treatment arm, the ongoing treatment may have influenced the clinical decision to transfer the patient to the ICU. In addition, the most severely ill infants could have been transferred more easily if they were already receiving HFOT. The proportion of intubations needed was 1.0% in the HFOT group and 0.5% in the standard therapy group (odds ratio 1.99, 95% confidence interval 0.60–6.65). Even though the sample size was very large, with a total of 1,472 infants, the study was underpowered to compare the rates of intubations, which were very rare in both groups. These two excellent studies documented the superiority of HFOT over low-flow standard therapy for oxygen administration in infants with bronchiolitis who needed oxygen supplementation. Two fundamental questions arise from the results. First, should we routinely use HFOT instead of low-flow oxygen administration for all bronchiolitis patients who need oxygen? Our answer to that is that the current evidence supports the use of HFOT. Yet, in the studies by Kepreotes et al. 1 and Franklin et al. 2, more than two-thirds of the bronchiolitis patients who needed oxygen supplementation could be treated with standard low-flow therapy and the rescue therapy with HFOT for children treated primarily with standard oxygen administration worked well. Second, do we need any more prospective studies in which infants with bronchiolitis are randomly allocated to HFOT or to standard oxygen arms? That is a most difficult question to answer and our view is that ideally the scientific community should still produce such data to verify whether such an approach would reduce transfers to the ICU and intubation rates. However, the sample sizes required for such studies would be very large. Furthermore, we do not know whether the early introduction of HFOT is capable of modifying the course of bronchiolitis. The studies by Kepreotes et al. 1 and Franklin et al. 2 both suggested that, at the very least, substantial modifications did not occur, as HFOT did not reduce the time that oxygen supplementation was needed. Finally, the effectiveness of HFOT may differ in children younger than 12 months with respiratory syncytial virus bronchiolitis and in children older than 12 months with rhinovirus-induced wheezing and asthma-like features. This study had no external funding. The authors have no conflict of interests to declare." @default.
• W2801591687 created "2018-05-17" @default.
• W2801591687 creator A5012331395 @default.
• W2801591687 creator A5064858145 @default.
• W2801591687 date "2018-05-11" @default.
• W2801591687 modified "2023-09-26" @default.
• W2801591687 title "High-flow oxygen therapy is safe and effective in infants with bronchiolitis" @default.
• W2801591687 cites W2179869139 @default.
• W2801591687 cites W2583256439 @default.
• W2801591687 cites W2792851500 @default.
• W2801591687 doi "https://doi.org/10.1111/apa.14365" @default.
• W2801591687 hasPubMedId "https://pubmed.ncbi.nlm.nih.gov/29750833" @default.
• W2801591687 hasPublicationYear "2018" @default.
• W2801591687 type Work @default.
• W2801591687 sameAs 2801591687 @default.
• W2801591687 citedByCount "0" @default.
• W2801591687 crossrefType "journal-article" @default.
• W2801591687 hasAuthorship W2801591687A5012331395 @default.
• W2801591687 hasAuthorship W2801591687A5064858145 @default.
• W2801591687 hasBestOaLocation W28015916871 @default.
• W2801591687 hasConcept C126322002 @default.
• W2801591687 hasConcept C177713679 @default.
• W2801591687 hasConcept C178790620 @default.
• W2801591687 hasConcept C185592680 @default.
• W2801591687 hasConcept C187212893 @default.
• W2801591687 hasConcept C2778821649 @default.
• W2801591687 hasConcept C2780630273 @default.
• W2801591687 hasConcept C2994142871 @default.
• W2801591687 hasConcept C42219234 @default.
• W2801591687 hasConcept C534529494 @default.
• W2801591687 hasConcept C540031477 @default.
• W2801591687 hasConcept C71924100 @default.
• W2801591687 hasConceptScore W2801591687C126322002 @default.
• W2801591687 hasConceptScore W2801591687C177713679 @default.
• W2801591687 hasConceptScore W2801591687C178790620 @default.
• W2801591687 hasConceptScore W2801591687C185592680 @default.
• W2801591687 hasConceptScore W2801591687C187212893 @default.
• W2801591687 hasConceptScore W2801591687C2778821649 @default.
• W2801591687 hasConceptScore W2801591687C2780630273 @default.
• W2801591687 hasConceptScore W2801591687C2994142871 @default.
• W2801591687 hasConceptScore W2801591687C42219234 @default.
• W2801591687 hasConceptScore W2801591687C534529494 @default.
• W2801591687 hasConceptScore W2801591687C540031477 @default.
• W2801591687 hasConceptScore W2801591687C71924100 @default.
• W2801591687 hasIssue "8" @default.
• W2801591687 hasLocation W28015916871 @default.
• W2801591687 hasLocation W28015916872 @default.
• W2801591687 hasOpenAccess W2801591687 @default.
• W2801591687 hasPrimaryLocation W28015916871 @default.
• W2801591687 hasRelatedWork W2045761706 @default.
• W2801591687 hasRelatedWork W2100204174 @default.
• W2801591687 hasRelatedWork W2125875138 @default.
• W2801591687 hasRelatedWork W2144792843 @default.
• W2801591687 hasRelatedWork W2411312676 @default.
• W2801591687 hasRelatedWork W2617092205 @default.
• W2801591687 hasRelatedWork W2930960273 @default.
• W2801591687 hasRelatedWork W3030510300 @default.
• W2801591687 hasRelatedWork W3145743791 @default.
• W2801591687 hasRelatedWork W4235434149 @default.
• W2801591687 hasVolume "107" @default.
• W2801591687 isParatext "false" @default.
• W2801591687 isRetracted "false" @default.
• W2801591687 magId "2801591687" @default.
• W2801591687 workType "article" @default.