High-flow oxygen therapy v. standard care in infants with viral bronchiolitis.

Background: High-flow humidified oxygen (HFHO) therapy has demonstrated benefit in infants with bronchiolitis. Objectives: To investigate the efficacy of HFHO in infants with moderate to severe viral bronchiolitis, when used outside the paediatric intensive care unit (PICU), in a hospital with limited PICU resources. Methods: A randomised controlled trial, which enrolled 28 infants between 1 month and 2 years of age, with a clinical diagnosis of acute viral bronchiolitis and moderate to severe respiratory distress. Participants were randomised to receive HFHO 2L/kg/min or oxygen by nasal cannula/ face mask. Respiratory rate, heart rate, oxygen saturations, and modified TAL (M-TAL) score were measured at baseline, 60 - 90 minutes after starting therapy and at 6- and 12-hourly intervals. The primary outcome evaluated was the improvement in respiratory distress (M-TAL score). The secondary outcome assessed was the need for intubation and ventilation. Results: There was a significant improvement in respiratory distress (M-TAL score), in infants who received HFHO therapy. Additionally, there was also a reduction in heart rate in the HFHO group as well as a trend to lower intubation rates. Conclusion: HFHO is a beneficial therapy for infants with moderate-severe viral bronchiolitis. It can be safely used outside the PICU and could potentially reduce the need for intubation and admission to PICU in resource-limited settings. Contributions of the study: High-flow humidified oxygen (HFHO) is effective in infants with moderate to severe bronchiolitis, and not only in those with milder forms of the disease. It can be safely used outside the paediatric intensive care unit, where adequate respiratory monitoring is available. This is important in low-resource areas where there may be insufficient critical care resources to manage these patients.