High flow therapy versus hypertonic saline in bronchiolitis: randomised controlled trial

Objective To demonstrate that heated humidified high-flow nasal cannula (HHHFNC) is superior to inhaled hypertonic saline solution (HSS) in improving respiratory distress in moderate bronchiolitis. In addition, it could improve comfort and reduce length of hospital stay (LOS) and admission to Paedia...

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Bibliographic Details
Published in:	Archives of disease in childhood Vol. 99; no. 6; pp. 511 - 515
Main Authors:	Bueno Campaña, Mercedes, Olivares Ortiz, Jorge, Notario Muñoz, Cristina, Rupérez Lucas, Marta, Fernández Rincón, Adelaida, Patiño Hernández, Olga, Calvo Rey, Cristina
Format:	Journal Article
Language:	English
Published:	London BMJ Publishing Group 01-06-2014 BMJ Publishing Group Ltd BMJ Publishing Group LTD
Subjects:	Acute Disease Administration, Inhalation Admission Criteria Airway management Biological and medical sciences Bronchiolitis Bronchiolitis - drug therapy Bronchiolitis - therapy Care and treatment Chronic obstructive pulmonary disease, asthma Clinical trials Evaluation Female General aspects Hospitalization Humans Infant Infant, Newborn Intensive Care Units, Pediatric Length of Stay - statistics & numerical data Male Medical sciences Miscellaneous Nurses Oxygen equipment (Medical care) Oxygen Inhalation Therapy - methods Oxygen therapy Patients Pediatrics Physiologic salines Pneumology Prevention and actions Protocol Analysis Public health. Hygiene Public health. Hygiene-occupational medicine Saline solution Saline Solution, Hypertonic - therapeutic use Severity of Illness Index Statistical analysis Treatment Outcome Ventilation Ventilators Young Children Spain Human High Pediatrics Respiratory disease Controlled therapeutic trial Randomized controlled trial Bronchiolitis Treatment Bronchus disease Clinical trial Child Comparative study Public health
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Summary:	Objective To demonstrate that heated humidified high-flow nasal cannula (HHHFNC) is superior to inhaled hypertonic saline solution (HSS) in improving respiratory distress in moderate bronchiolitis. In addition, it could improve comfort and reduce length of hospital stay (LOS) and admission to Paediatric Intensive Care Unit (PICU). Design Randomised Clinical Trial from 1 October 2010 to 31 December 2012. Setting Two urban secondary (no PICU available) paediatric hospitalisation units. Patients Hospitalised children aged up to 6 months with moderate acute bronchiolitis (Respiratory Distress Assessment Instrument, RDAI ≥4). Intervention Patients were randomised to HHHFNC or HSS. All of them received epinephrine as bronchodilator. Main outcomes Primary outcome was difference in mean Respiratory Assessment Change Score (RACS) between both groups measured in six previously defined consecutive moments. Secondary outcomes were difference in mean comfort scores in this period, LOS and rate of PICU admission. Results Seventy-five previously healthy patients were enrolled. Mean age was 2.4 months (95% CI 2.04 to 2.76). 43 were allocated to HSS group and 32 in HHHFNC. Data of 1 patient were lost, and 8 changed group over the study period. Intention-to-treat principle was applied. There were no significant differences in mean RACS and mean comfort scores between groups at the evaluation points. Median LOS or PICU admission rate were similar in both groups. No adverse events were observed. Conclusions HHHFNC was not superior to HSS in treatment of moderate acute bronchiolitis with respect to severity and comfort scores, LOS or PICU admission rate. Clinical Trial Registration ClinicalTrials.gov Identifier NCT01873144.
Bibliography:	ObjectType-Article-2 SourceType-Scholarly Journals-1 ObjectType-News-1 ObjectType-Feature-3 content type line 23
ISSN:	0003-9888 1468-2044
DOI:	10.1136/archdischild-2013-305443