Interest of high flow nasal cannula versus nasal continuous positive airway pressure during the management of severe bronchiolitis in infants: A multicenter randomized controlled trial. Milesi C., Essouri S., Pouyau R., Liet J.M., Afanetti M., Baleine J., Durand S., Cambonie G., Breinig S., & Javouhey E. 2016.
abstract   bibtex   
Background and aims Concerning the management of severe bronchiolitis, HFNC is increasingly used even if there are no randomized studies evaluating its efficacy and safety. Our objective was to evaluate the failure rate of HFNC compared to the nCPAP during the initial management of severe bronchiolitis. Methods Prospective, controlled, randomized, multicenter study. Infants from 0 to 6 months old, admitted in PICU for severe bronchiolitis (ModifiedWood score\textgreater 3) were randomized into two groups: "HFNC" (2 l/kg/min) and "nCPAP" (6 cm H2O) during 24 hours. The primary endpoint was the percentage of failure in both arms during the first 24 hours. Failure was define as an Increase of (1) clinical score for respiratory distress (mWCAS) or (2) Respiratory rate (RR) or (3) discomfort (EDIN score) or (4) apnea. Results \median (SD) and %(IC)\ 142 infants were included from november 2014 to march 2015;71were randomized in HFNC group and 71 in the nCPAP group. They were 40 (35) days old the RR: 53 (13), FiO2: 30 (12), mWCAS: 4.3 (1) , PCO2: 59 (14) mmHg, pH: 7.28 (0.1). There was no difference between the two groups (weight, age, HR, RR, FIO2, mWCAS, EDIN, PCO2). The failure rate was higher in the HFNC group 49 (39-62) vs 31 (20-42)%; OR: 0.49 (0.2-0.9) p = 0.018). We didn't find any predictive failure criteria. Failure occurred rapidly during the first 18 hours in the two groups. Conclusions During severe bronchiolitis management, the failure rate is higher with the high flow compared with nasal CPAP.
@misc{milesi_c._interest_2016,
	title = {Interest of high flow nasal cannula versus nasal continuous positive airway pressure during the management of severe bronchiolitis in infants: {A} multicenter randomized controlled trial},
	abstract = {Background and aims Concerning the management of severe bronchiolitis, HFNC is increasingly used even if there are no randomized studies evaluating its efficacy and safety. Our objective was to evaluate the failure rate of HFNC compared to the nCPAP during the initial management of severe bronchiolitis. Methods Prospective, controlled, randomized, multicenter study. Infants from 0 to 6 months old, admitted in PICU for severe bronchiolitis (ModifiedWood score{\textgreater} 3) were randomized into two groups: "HFNC" (2 l/kg/min) and "nCPAP" (6 cm H2O) during 24 hours. The primary endpoint was the percentage of failure in both arms during the first 24 hours. Failure was define as an Increase of (1) clinical score for respiratory distress (mWCAS) or (2) Respiratory rate (RR) or (3) discomfort (EDIN score) or (4) apnea. Results \{median (SD) and \%(IC)\} 142 infants were included from november 2014 to march 2015;71were randomized in HFNC group and 71 in the nCPAP group. They were 40 (35) days old the RR: 53 (13), FiO2: 30 (12), mWCAS: 4.3 (1) , PCO2: 59 (14) mmHg, pH: 7.28 (0.1). There was no difference between the two groups (weight, age, HR, RR, FIO2, mWCAS, EDIN, PCO2). The failure rate was higher in the HFNC group 49 (39-62) vs 31 (20-42)\%; OR: 0.49 (0.2-0.9) p = 0.018). We didn't find any predictive failure criteria. Failure occurred rapidly during the first 18 hours in the two groups. Conclusions During severe bronchiolitis management, the failure rate is higher with the high flow compared with nasal CPAP.},
	journal = {European Journal of Pediatrics},
	author = {{Milesi C.} and {Essouri S.} and {Pouyau R.} and {Liet J.M.} and {Afanetti M.} and {Baleine J.} and {Durand S.} and {Cambonie G.} and {Breinig S.} and {Javouhey E.}},
	year = {2016},
	keywords = {*bronchiolitis, *nasal cannula, *positive end expiratory pressure, apnea monitoring, breathing rate, carbon dioxide tension, clinical trial, controlled clinical trial, controlled study, human, infant, major clinical study, multicenter study, randomized controlled trial, respiratory distress, treatment failure, water}
}
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