High-flow oxygen boost for bronchiolitis

Feb 3 2017

High-flow oxygen recipient Oscar with his mother Jenny and Dr Elizabeth Kepreotes

A study conducted at the John Hunter Children’s Hospital has found that the use of a new oxygen treatment, so-called high-flow oxygen therapy, can support more children with bronchiolitis for longer and rescue most of those children who failed the standard oxygen treatment, preventing a large number of admissions to the paediatric intensive care unit.

As the first completed clinical trial on high-flow oxygen in children, it confirmed its safety and effectiveness. The results have just been published in the prestigious international medical journal The Lancet

Commonly affecting children under 2 years of age, bronchiolitis is the most common cause for admission to hospital and intensive care units in the Hunter and developed countries in this age group. The usual treatment is rest and nutritive support, combined with low-flow oxygen.

The trial, involving 202 babies, found that high-flow oxygen was needed for a similar length of time when first administered, however it supported more infants for longer as compared to the standard low-flow oxygen therapy. Most children who failed standard therapy were rescued with high-flow oxygen, preventing intensive care intervention.

Lead investigator Dr Elizabeth Kepreotes, a Clinical Nurse Consultant at John Hunter Children’s Hospital and a researcher at the University of Newcastle Priority Research Centre GrowUpWell, said that important clinical improvements for children and their families had resulted from the trial.

“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,” Dr Kepreotes said.

“Time on standard therapy averaged at 24 hours, while high-flow oxygen was needed for 20 hours. We have also reduced the length of hospitalisation from an average of 3 days to 2 days.

“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.”

Parents of the babies rated high-flow oxygen as being more comfortable and more supportive during feeding than standard oxygen therapy.

Five-year-old Oscar, pictured with his mother Jenny and Dr Kepreotes (right), was admitted to hospital 4 years ago with bronchiolitis and recruited to the study. He was in for only one night on the trial treatment method and continues to have follow-up lung function tests at JHCH.

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.

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

* Dr Elizabeth Kepreotes is a member of the University of Newcastle’s Priority Research Centre GrowUpWellÒ (Director Prof Joerg Mattes), researching in conjunction with the Hunter Medical Research Institute (HMRI). HMRI is a partnership between the University of Newcastle, Hunter New England Health and the community.

Photograph courtesy of Lucas Coleman, John Hunter Children's Hospital