Background: Bronchiolitis is the most common reason for hospital admission in infants, with one third requiring oxygen therapy due to hypoxemia. It is unknown what proportion of hypoxemic infants with bronchiolitis can be managed with nasal high-flow in room air and their resulting outcomes. Objectives and Settings: To assess the effect of nasal high-flow in room air in a subgroup of infants with bronchiolitis allocated to high-flow therapy in a recent multicenter randomized controlled trial. Patients and Interventions: Infants allocated to the high-flow arm of the trial were initially treated with room air high-flow if saturations were ≥85%. Subsequently, if oxygen saturations did not increase to ≥92%, oxygen was added and FiO2 was titrated to increase the oxygen saturations. In this planned sub-study, infants treated during their entire hospital stay with high-flow room air only were compared to infants receiving either standard-oxygen or high-flow with oxygen. Baseline characteristics, hospital length of stay and length of oxygen therapy were compared. Findings: In the per protocol analysis 64 (10%) of 630 infants commenced on high-flow room air remained in room air only during the entire stay in hospital. These infants on high-flow room air were on average older and presented with moderate hypoxemia at presentation to hospital. Their length of respiratory support and length of stay was also significantly shorter. No pre-enrolment factors could be identified in a multivariable analysis. Conclusions: In a small sub-group of hypoxemic infants with bronchiolitis hypoxemia can be reversed with the application of high-flow in room air only. Trial registration: ACTRN12615001305516.

译文

背景:毛细支气管炎是婴儿住院的最常见原因,三分之一由于低氧血症而需要氧疗。尚不清楚通过鼻腔高流量的室内空气处理低氧血症性毛细支气管炎婴儿的比例及其结果。目的和背景:在最近的一项多中心随机对照试验中,评估分配给高流量治疗的细支气管炎婴儿亚组鼻腔高流量在室内空气中的作用。患者和干预措施:如果饱和度≥85%,则首先使用室内空气高流量治疗分配给该试验高流量臂的婴儿。随后,如果氧饱和度未增加到≥92%,则添加氧并滴定FiO2以增加氧饱和度。在此计划的子研究中,将仅在整个住院期间使用高流量室内空气治疗的婴儿与接受标准氧气或高流量氧气的婴儿进行了比较。比较基线特征,住院时间和氧疗时间。研究结果:根据方案分析,仅在住院期间,630名婴儿中有64名(10%)使用高流量的室内空气开始留在室内。这些高流量室内空气的婴儿平均年龄较大,到医院就诊时出现中度低氧血症。他们的呼吸支持时间和住院时间也明显缩短。在多变量分析中无法确定入学前因素。结论:在一小部分低氧血症的毛细支气管炎婴儿中,仅在室内空气中高流量可逆转低氧血症。试用注册:ACTRN12615001305516。

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