Hunter research study published in prestigious UK medical journal The Lancet

3rd February 2017


Hunter clinicians and researchers have been recognised for their study into high-flow oxygen therapy in bronchiolitis, which has just been published in the prestigious UK medical journal, The Lancet.

As the first completed clinical trial examining the safety and effectiveness of high-flow oxygen therapy in children, this study answers the call from the European Respiratory Society Congress of 2016 for trials into this paediatric priority research area.

Bronchiolitis is a viral lung infection that mainly affects children under two-years-of-age. It is the most common cause for admission to hospital and intensive care units in the Hunter and in developed countries in this age group. The usual treatment for moderate bronchiolitis is rest and nutritive support, with cold, low-flow nasal cannula oxygen therapy to a maximum of 2 Litres/minute used to maintain oxygen saturation levels above 95%.

The open, randomised controlled trial (HFWHO RCT) was conducted by clinicians and researchers from the John Hunter Children’s Hospital, John Hunter Hospital, the Hunter Medical Research Institute, and the University of Newcastle. The team investigated whether high-flow warm humidified oxygen provided better support for babies than standard low-flow nasal cannula oxygen in those with moderate bronchiolitis by reducing the time that oxygen was needed

The trial, involving 202 babies, found that high-flow warm humidified oxygen and standard oxygen therapy were needed for similar lengths of time when oxygen was started at maximum therapy and then weaned in a standardised way in response to changes in the babies’ observations. However, standard therapy failed to support one third of the children who were randomised to it. Of these babies, 32/33 were allowed to trial high-flow oxygen as a rescue therapy and 20 improved without requiring the intensive care interventions they would previously have needed. Intensive Care admission rates were then similar for both therapies, with 26 babies going on to required additional support for severe/life-threatening bronchiolitis.

The study’s lead investigator, Dr Elizabeth Kepreotes, a Clinical Nurse Consultant at John Hunter Children’s Hospital, and researcher with the Hunter Medical Research Institute and the University of Newcastle’s Priority Research Centre GrowUpWellÒ, said that important clinical improvements for the children and their families have come about as a result of the trial.

‘Babies who were admitted to the John Hunter Children’s Hospital needing supplemental oxygen, received maximum oxygen therapy on their allocated treatment for a minimum of three hours, before oxygen was weaned if their observations had stabilised. Time on standard therapy fell from an average of 38 hours in 2007 down to 24 hours, and high-flow oxygen was needed for an average of 20 hours,’ said Dr Kepreotes.

The researchers concluded that high-flow oxygen therapy, used at 1L/kg/min in babies with bronchiolitis, is a safe and effective therapy for use in paediatric wards and emergency departments. It may also prevent or reverse clinical deterioration in some babies, reducing transfers to Intensive Care Units. Importantly, parents of the babies rated high-flow oxygen as being more comfortable and more supportive during feeding than standard oxygen therapy, while there was no difference in sleep quality.

‘Less time on oxygen and improved methods of recognising and responding to clinical deterioration has led to improvements in the treatment of bronchiolitis in our hospital. By standardising our management of oxygen therapy for the trial, we have also reduced the length of hospitalisation from an average of 3 days to 2 days, regardless of the therapy used,’ Dr Kepreotes said.

‘A reduced length of stay benefits the baby, their family, along with other children who need access to a hospital bed. The economic and clinical benefits of reducing intensive care admissions through the use of high-flow oxygen are also important findings,’ she said.

Funding for the study was provided by the John Hunter Children's Hospital Respiratory Charitable Trust and the Hunter Children’s Research Foundation. The HFWHO RCT was conducted independently of the manufacturers.

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