Evidence map›Paper›PMID 29866165›Full record

Trial reportCritical care (London, England)2018

FIRST-line support for Assistance in Breathing in Children (FIRST-ABC): a multicentre pilot randomised controlled trial of high-flow nasal cannula therapy versus continuous positive airway pressure in paediatric critical care.

Padmanabhan Ramnarayan, Paula Lister, Troy Dominguez, Parviz Habibi, Naomi Edmonds, Ruth R Canter, Jerome Wulff, David A Harrison, Paul M Mouncey, Mark J Peters and 1 more

Registry-linked trialOpen access · goldAbstract readMulticenter StudyRandomized Controlled TrialPragmatic Clinical Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in Critical care (London, England), 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT02612415 (FIRST-ABC Feasibility Study), which is not on this map. Cited by 34 papers, 8 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
34citing papers in PubMed, 8 pooled it
4.9field-weighted citation impact, top 4% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT02612415 phase2 / phase3completednot on this map

FIRST-ABC Feasibility Study: Feasibility Study for a Randomised Trial of High Flow Nasal Cannula (HFNC) Versus Continuous Positive Airway Pressure (CPAP) for Non-invasive Respiratory Support in Critically Ill Children

TypeinterventionalSponsorGreat Ormond Street Hospital for Children NHS Foundation TrustRan2015 to 2016Enrolled121ConditionsHypoxia, Respiratory Acidosis, Moderate/Severe Respiratory DistressArmsTreatment strategy: Non-invasive respiratory support delivered via high flow nasal cannula, Treatment strategy: Non-invasive respiratory support delivered via continuous positive airway pressure
3 · Its place in the literature

Who cites it

34 citing papers in PubMed, 8 syntheses or guidelines pooled it, 64 citations in OpenAlex.

  1. Respiratory support in paediatric patients with bronchiolitis: a systematic review and meta-analysis.European respiratory review : an official journal of the European Respiratory Society · 2026
    Pooled it
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  3. High flow nasal cannula for respiratory support in term infants.The Cochrane database of systematic reviews · 2023
    Pooled it
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  5. Guideline
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

11 authors at 4 institutions in 1 country.

Padmanabhan RamnarayanChildren's Acute Transport Service, Critical Care Division, Great Ormond Street Hospital NHS Foundation Trust, 26-27 Boswell Street, London, WC1N 3JZ, UK. p.ramnarayan@gosh.nhs.uk.ORCID http://orcid.org/0000-0003-0784-8154
Paula ListerPaediatric and Neonatal Intensive Care Unit, Critical Care Division, Great Ormond Street Hospital NHS Foundation Trust, London, UK.
Troy DominguezCardiac Intensive Care Unit, Critical Care Division, Great Ormond Street Hospital NHS Foundation Trust, London, UK.
Parviz HabibiPaediatric Intensive Care Unit, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK.
Naomi EdmondsPaediatric Critical Care Unit, Royal London Hospital, Barts Health NHS Trust, London, UK.
Ruth R CanterClinical Trials Unit, Intensive Care National Audit & Research Centre (ICNARC), Napier House, High Holborn, London, UK.
Jerome WulffClinical Trials Unit, Intensive Care National Audit & Research Centre (ICNARC), Napier House, High Holborn, London, UK.
David A HarrisonClinical Trials Unit, Intensive Care National Audit & Research Centre (ICNARC), Napier House, High Holborn, London, UK.
Paul M MounceyClinical Trials Unit, Intensive Care National Audit & Research Centre (ICNARC), Napier House, High Holborn, London, UK.
Mark J PetersPaediatric and Neonatal Intensive Care Unit, Critical Care Division, Great Ormond Street Hospital NHS Foundation Trust, London, UK.
United Kingdom Paediatric Intensive Care Society Study Group (PICS-SG)
Intensive Care National Audit & Research Centre · GBGreat Ormond Street Hospital for Children NHS Foundation Trust · GBImperial College Healthcare NHS Trust · GBBarts Health NHS Trust · GB

Funding

Department of Health HTA/15/44/01Great Ormond Street Hospital Charity V0315
6 · The paper itself

Abstract

backgroundAlthough high-flow nasal cannula therapy (HFNC) has become a popular mode of non-invasive respiratory support (NRS) in critically ill children, there are no randomised controlled trials (RCTs) comparing it with continuous positive airway pressure (CPAP). We performed a pilot RCT to explore the feasibility, and inform the design and conduct, of a future large pragmatic RCT comparing HFNC and CPAP in paediatric critical care.

methodsIn this multi-centre pilot RCT, eligible patients were recruited to either Group A (step-up NRS) or Group B (step-down NRS). Participants were randomised (1:1) using sealed opaque envelopes to either CPAP or HFNC as their first-line mode of NRS. Consent was sought after randomisation in emergency situations. The primary study outcomes were related to feasibility (number of eligible patients in each group, proportion of eligible patients randomised, consent rate, and measures of adherence to study algorithms). Data were collected on safety and a range of patient outcomes in order to inform the choice of a primary outcome measure for the future RCT.

resultsOverall, 121/254 eligible patients (47.6%) were randomised (Group A 60%, Group B 44.2%) over a 10-month period (recruitment rate for Group A, 1 patient/site/month; Group B, 2.8 patients/site/month). In Group A, consent was obtained in 29/33 parents/guardians approached (87.9%), while in Group B 84/118 consented (71.2%). Intention-to-treat analysis included 113 patients (HFNC 59, CPAP 54). Most reported adverse events were mild/moderate (HFNC 8/59, CPAP 9/54). More patients switched treatment from HFNC to CPAP (Group A: 7/16, 44%; Group B: 9/43, 21%) than from CPAP to HFNC (Group A: 3/13, 23%; Group B: 5/41, 12%). Intubation occurred within 72 h in 15/59 (25.4%) of HFNC patients and 10/54 (18.5%) of CPAP patients (p = 0.38). HFNC patients experienced fewer ventilator-free days at day 28 (Group A: 19.6 vs. 23.5; Group B: 21.8 vs. 22.2).

conclusionsOur pilot trial confirms that, following minor changes to consent procedures and treatment algorithms, it is feasible to conduct a large national RCT of non-invasive respiratory support in the paediatric critical care setting in both step-up and step-down NRS patients.

trial registrationclinicaltrials.gov, NCT02612415 . Registered on 23 November 2015.

Indexed as

CannulaChildChild, PreschoolContinuous Positive Airway PressureCritical CareCritical Care OutcomesFemaleHumansInfantIntensive Care Units, PediatricLondonMaleOxygen Inhalation TherapyPilot ProjectsContinuous positive airway pressureHigh-flow nasal cannula therapyNon-invasive respiratory supportPaediatric critical care

Identifiers

PMID29866165
PMCPMC5987627
OpenAlexW2806973333

What OpenQuestion holds

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LicenceCC BY
Read underepoch 390

Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.