Trial reportIntensive care medicine2018
A multicenter randomized controlled trial of a 3-L/kg/min versus 2-L/kg/min high-flow nasal cannula flow rate in young infants with severe viral bronchiolitis (TRAMONTANE 2).
Trial report in Intensive care medicine, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 3 registered trials, which are not on this map. Cited by 37 papers, 5 of them syntheses that pooled it.
What it found
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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.
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.
Comparison Between 2l/Min/kg vs 3l/Min/kg in High Flow Nasal Cannula (HFNC) During the Initial Management of Severe Bronchiolitis in Infants
Comparison of High Flow Nasal Cannula and Standard Face Mask Oxygen Therapy in Children With Moderate and Severe Bronchiolitis; a Randomized Controlled Trial
Impact of Increasing Flow Rates in High-flow Nasal Cannula and CPAP on Diaphragmatic Work in Newborn and Paediatric Population: Non-inferiority Study
Who cites it
37 citing papers in PubMed, 5 syntheses or guidelines pooled it, 99 citations in OpenAlex.
- High-flow nasal cannula for lower respiratory infections in children under 2 years: a systematic review of indications.Archives of disease in childhood · 2026Pooled it
- Application of the TIDieR checklist to improve the HFNC use in bronchiolitis management.European journal of pediatrics · 2024Pooled it
- High-flow nasal cannula therapy for infants with bronchiolitis.The Cochrane database of systematic reviews · 2024Pooled it
- Efficacy and safety of high flow nasal oxygen for children with bronchiolitis: systematic review and meta-analysis.BMJ open respiratory research · 2021Pooled it
- High flow nasal cannula as respiratory support in treating infant bronchiolitis: a systematic review.European journal of pediatrics · 2020Pooled it
- Comparison of 3 different flow rates of high-flow nasal cannula (1 L/kg/min versus 2 L/kg/min versus 3 L/kg/min) in management of children admitted with bronchiolitis: a randomized controlled trial.European journal of pediatrics · 2025Trial
- Comparison of heated humidified high-flow nasal cannula flow rates (1-L·kg·minPediatric pulmonology · 2019Trial
- Standardizing HFNC for bronchiolitis: a quality improvement protocol in an Italian children's hospital.European journal of pediatrics · 2026Article
- Clinical Interventions During Inter-hospital Transfer of Infants With Moderate-to-Severe Bronchiolitis: Implications for Advanced Nursing Practice.Nursing in critical care · 2026Observational
- Implementation of a nursing- and respiratory therapist-led high-flow nasal cannula pathway is associated with decreased ICU length of stay in bronchiolitis.Frontiers in pediatrics · 2026Article
- Reply to: Predictive factors for high-flow nasal cannula failure in patients with acute viral bronchiolitis admitted to the pediatric intensive care unit.Critical care science · 2026Article
- Epidemiologic evaluation of pediatric patients receiving high-flow nasal cannula therapy in the pediatric emergency department.Medicine · 2025Observational
- Predictive factors for high-flow nasal cannula failure in patients with acute viral bronchiolitis admitted to the pediatric intensive care unit.Critical care science · 2025Article
- High-flow weaning strategies for infants with bronchiolitis: protocol for a pilot randomised controlled trial in the UK.BMJ open · 2024Article
- High-flow nasal cannula is an expensive and clunky placebo: myth or maxim?Breathe (Sheffield, England) · 2024Review
- High-Flow and Low-Flow Oxygen Delivery by Nasal Cannula Evaluated in Infant and Adult Airway Replicas.Respiratory care · 2024Article
- Critical care of severe bronchiolitis during shortage of ICU resources.EClinicalMedicine · 2024Review
- The effects of flow settings during high-flow nasal cannula oxygen therapy for neonates and young children.European respiratory review : an official journal of the European Respiratory Society · 2024Review
- Associations With Severe Desaturation Events Among Children Receiving Noninvasive Respiratory Support at Time of Intubation.Respiratory care · 2023Article
- Acute Viral Bronchiolitis: A Narrative Review.Journal of pediatric intensive care · 2023Review
Corrections and comments
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Authors and funding
28 authors at 10 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
purposeHigh-flow nasal cannula (HFNC) therapy is increasingly proposed as first-line respiratory support for infants with acute viral bronchiolitis (AVB). Most teams use 2 L/kg/min, but no study compared different flow rates in this setting. We hypothesized that 3 L/kg/min would be more efficient for the initial management of these patients.
methodsA randomized controlled trial was performed in 16 pediatric intensive care units (PICUs) to compare these two flow rates in infants up to 6 months old with moderate to severe AVB and treated with HFNC. The primary endpoint was the percentage of failure within 48 h of randomization, using prespecified criteria of worsening respiratory distress and discomfort.
resultsFrom November 2016 to March 2017, 142 infants were allocated to the 2-L/kg/min (2L) flow rate and 144 to the 3-L/kg/min (3L) flow rate. Failure rate was comparable between groups: 38.7% (2L) vs. 38.9% (3L; p = 0.98). Worsening respiratory distress was the most common cause of failure in both groups: 49% (2L) vs. 39% (3L; p = 0.45). In the 3L group, discomfort was more frequent (43% vs. 16%, p = 0.002) and PICU stays were longer (6.4 vs. 5.3 days, p = 0.048). The intubation rates [2.8% (2L) vs. 6.9% (3L), p = 0.17] and durations of invasive [0.2 (2L) vs. 0.5 (3L) days, p = 0.10] and noninvasive [1.4 (2L) vs. 1.6 (3L) days, p = 0.97] ventilation were comparable. No patient had air leak syndrome or died.
conclusionIn young infants with AVB supported with HFNC, 3 L/kg/min did not reduce the risk of failure compared with 2 L/kg/min. This clinical trial was recorded on the National Library of Medicine registry (NCT02824744).
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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.