Study of High-flow Oxygen Therapy Against Standard Therapy in Bronchiolitis (Hi-Flo)
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Purpose
Bronchiolitis is a common illness of the respiratory tract caused by infection of the tiny airways within the lungs called bronchioles. At present the standard care of hospitalized children with bronchiolitis is oxygen via nasal prongs. In this study the investigators would like to compare standard ward management with a new method of delivering oxygen called high flow nasal cannula oxygen therapy (HFNOT). HFNOT involves breathing warmed, moistened oxygen through nasal cannulae at a flow rate of 8 liters/minute. Accumulated experience suggests that HFNOT eases the child's work of breathing and reduces need for ICU admission and invasive respiratory support.
| Condition | Intervention |
|---|---|
|
Bronchiolitis |
Procedure: High Flow Nasal Cannula Oxygen Therapy Other: Standard low flow oxygen |
| Study Type: | Interventional |
| Study Design: | Allocation: Randomized Endpoint Classification: Efficacy Study Intervention Model: Parallel Assignment Masking: Open Label Primary Purpose: Treatment |
| Official Title: | A Prospective Open Randomized Clinical Trial Comparing High Flow Nasal Cannula Oxygen Therapy Against Standard Therapy for Children Hospitalized With Bronchiolitis |
- Length of hospital stay [ Time Frame: Expected average length of stay 5 days ] [ Designated as safety issue: No ]Number of hours that the patient remains in hospital.
- Admission to Intensive Care Unit [ Time Frame: During hospitalisation for bronchiolitis, expected average 5 days ] [ Designated as safety issue: No ]Yes or No
- Work of breathing [ Time Frame: During hospital stay, expected average 5 days ] [ Designated as safety issue: No ]Work of breathing, assessed by respiratory rate, at four timepoints on day one, and daily thereafter
| Estimated Enrollment: | 100 |
| Study Start Date: | December 2011 |
| Estimated Study Completion Date: | May 2013 |
| Estimated Primary Completion Date: | May 2013 (Final data collection date for primary outcome measure) |
| Arms | Assigned Interventions |
|---|---|
|
Active Comparator: Control
Standard low-flow oxygen therapy.
|
Other: Standard low flow oxygen
Standard low flow oxygen will be given to patients to maintain saturations greater than 92%.
|
|
Experimental: Intervention
High Flow Nasal Cannula Oxygen Therapy
|
Procedure: High Flow Nasal Cannula Oxygen Therapy
Warm humidified oxygen will be delivered at 8 liters/minute via nasal cannulae, at a concentration that maintains saturations greater than 92%.
Other Name: High flow oxygen therapy
|
Detailed Description:
We propose a prospective open randomised controlled trial to compare high flow nasal cannula oxygen therapy (HFNOT) with standard oxygen therapy for infants hospitalised with bronchiolitis. This study will be the first of its kind, as currently there is no evidence in the published literature.
All children will be cared for by the same medical team on two wards. All aspects of care other than oxygen delivery will not be specified, and be at the discretion of the physicians. HFNOT will not be used as an escalation of care on the wards.
Randomisation will be performed by REDcap, in blocks of 6 patients. Patients will be identified in Emergency, informed consent obtained, and treatment started prior to transfer to the ward.
For patients randomised to HFNOT, the flow rate will be fixed at 8 liters/minute, and the inspired oxygen concentration titrated to maintain saturations above 92%.
Interim statistical analysis will be conducted to determine any positive or negative effect of HFNOT therapy. The first interval analysis will be performed after 50 subjects, the second after 100 subjects. If an effect is found, the study will be terminated following discussion with the hospital statistician and ethics board. Whichever treatment arm is found to be beneficial will be instituted as standard care for children with bronchiolitis.
Eligibility| Ages Eligible for Study: | up to 18 Months |
| Genders Eligible for Study: | Both |
| Accepts Healthy Volunteers: | No |
Inclusion Criteria:
- All children under 18 months of age with a clinical diagnosis of bronchiolitis requiring admission to hospital for observation and oxygen.
Exclusion Criteria:
- Infants admitted directly to ICU from Emergency.
- Prior positive pressure home ventilation.
- Tracheostomy.
- Nasogastric tubes in situ on admission.
- Upper airway abnormality.
- Congenital heart disease.
Contacts and Locations| Contact: Claire Hathorn, MD | 604 875 2119 | Claire.Hathorn@cw.bc.ca |
| Contact: Michael Seear, MD | 604 875 2119 | mseear@cw.bc.ca |
| Canada, British Columbia | |
| British Columbia Children's Hospital | Recruiting |
| Vancouver, British Columbia, Canada, V6H 3N1 | |
| Principal Investigator: | David Wensley, MD | British Columbia Children's Hospital |
More Information
No publications provided
| Responsible Party: | University of British Columbia |
| ClinicalTrials.gov Identifier: | NCT01498094 History of Changes |
| Other Study ID Numbers: | H11-03032 |
| Study First Received: | December 16, 2011 |
| Last Updated: | September 19, 2012 |
| Health Authority: | Canada: Health Canada |
Keywords provided by University of British Columbia:
|
Bronchiolitis High Flow Oxygen |
Therapy Nasal Cannulae Prongs |
Additional relevant MeSH terms:
|
Bronchiolitis Bronchitis Bronchial Diseases Respiratory Tract Diseases |
Lung Diseases, Obstructive Lung Diseases Respiratory Tract Infections |
ClinicalTrials.gov processed this record on May 16, 2013