Title :

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)

Author(s) :

Milesi, Christophe [Auteur]
Pierre, Anne-Florence [Auteur]
Deho, Anna [Auteur]
Pouyau, Robin [Auteur]
Liet, Jean-Michel [Auteur]
Guillot, Camille [Auteur]
Guilbert, Anne-Sophie [Auteur]
Rambaud, Jerome [Auteur]
Millet, Astrid [Auteur]
Afanetti, Mickael [Auteur]
Guichoux, Julie [Auteur]
Genuini, Mathieu [Auteur]
Mansir, Thierry [Auteur]
Bergounioux, Jean [Auteur]
Michel, Fabrice [Auteur]
Marcoux, Marie-Odile [Auteur]
Baleine, Julien [Auteur]
Durand, Sabine [Auteur]
Durand, Philippe [Auteur]
Dauger, Stéphane [Auteur]
Javouhey, Etienne [Auteur]
Leteurtre, Stephane [Auteur]
Evaluation des technologies de santé et des pratiques médicales - ULR 2694 [METRICS]
Brissaud, Olivier [Auteur]
Renolleau, Sylvain [Auteur]
Portefaix, Aurelie [Auteur]
Douillard, Aymeric [Auteur]
Cambonie, Gilles [Auteur]

Journal title :

Intensive care medicine

Abbreviated title :

Intensive Care Med

Publication date :

2018-10-21

ISSN :

1432-1238

English keyword(s) :

High-flow nasal cannula
Respiratory therapy
Infant
Oxygen inhalation therapy
Respiratory syncytial virus
Randomized controlled trial
Noninvasive ventilation
Bronchiolitis

HAL domain(s) :

Sciences du Vivant [q-bio]

English abstract : [en]

OBJECTIVE: High-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 ...
Show more >OBJECTIVE: High-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. METHODS: A 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. RESULTS: From 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. CONCLUSIONS: In 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).Show less >

Language :

Anglais

Audience :

Internationale

Popular science :

Non

Administrative institution(s) :

CHU Lille
Université de Lille

Collections :

• METRICS : Evaluation des technologies de santé et des pratiques médicales - ULR 2694

Submission date :

2019-12-09T18:19:32Z