Journal Summary

Researchers conducted a multicenter, RCT on1,472 infants (<12 months of age) with bronchiolitis who were in need of supplemental oxygen therapy to maintain and O₂sat between 92-98%. The patients were assigned on a 1:1 basis to receive either high-flow oxygen therapy (heated and humidified high-flow O₂at a rate of 2L/kg) or standard O₂therapy (maximum rate of 2L/min). The primary outcome was escalation of care due to failure of treatment, determined by meeting 3 of 4 clinical criteria:

• HR remained the same or increased since admission
• RR remained the same or increased since admission
• The O₂requirement in the high-flow group exceeded a fraction of inspired O₂≥ 0.4 to maintain an O₂sat of 92%
• The O₂requirement of standard O₂≥ 2L/min to maintain an O₂sat of 92%

What was discovered through the study is that the use of standard-therapy or high-flow O₂in infants with bronchiolitis in need of oxygen therapy did not change the length of hospital stay or the length of time that oxygen therapy was required. However, the use of high-flow oxygen decreased the need for escalation of care, even in the majority of patients that failed standard oxygen therapy, high-flow oxygen was used to mitigate the need for invasive procedures.

• Escalation of care was needed in 167 of 733 (23%) of infants in the standard therapy group as compared with 87 of 793 (12%) in the high-flow group
• Of the 167 infants that failed standard oxygen therapy, 102 (61%) had a response to high-flow therapy and need not require escalation of care

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