Study of High-flow Oxygen Therapy Against Standard Therapy in Bronchiolitis (Hi-Flo)

Study Description

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Brief Summary:

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 or disease	Intervention/treatment	Phase
Bronchiolitis	Procedure: High Flow Nasal Cannula Oxygen Therapy; Other: Standard low flow oxygen	Not Applicable

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.

Study Design

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Study Type :	Interventional (Clinical Trial)
Actual Enrollment :	79 participants
Allocation:	Randomized
Intervention Model:	Parallel Assignment
Masking:	None (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
Study Start Date :	December 2011
Actual Primary Completion Date :	July 2014
Actual Study Completion Date :	December 2014

Arms and Interventions

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Study Description Study Design Arms and Interventions Outcome Measures Eligibility Criteria Contacts and Locations More Information

Arm	Intervention/treatment
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

Outcome Measures

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Primary Outcome Measures :

1. Length of hospital stay [ Time Frame: Expected average length of stay 5 days ]
   Number of hours that the patient remains in hospital.

Secondary Outcome Measures :

1. Admission to Intensive Care Unit [ Time Frame: During hospitalisation for bronchiolitis, expected average 5 days ]
   Yes or No
2. Work of breathing [ Time Frame: During hospital stay, expected average 5 days ]
   Work of breathing, assessed by respiratory rate, at four timepoints on day one, and daily thereafter

Eligibility Criteria

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Study Description Study Design Arms and Interventions Outcome Measures Eligibility Criteria Contacts and Locations More Information

Ages Eligible for Study:	up to 18 Months (Child)
Sexes Eligible for Study:	All
Accepts Healthy Volunteers:	No

Criteria

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

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Study Description Study Design Arms and Interventions Outcome Measures Eligibility Criteria Contacts and Locations More Information

Locations

Canada, British Columbia
British Columbia Children's Hospital
Vancouver, British Columbia, Canada, V6H 3N1

Sponsors and Collaborators

University of British Columbia

Investigators

Principal Investigator:	David Wensley, MD	British Columbia Children's Hospital

More Information

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Study Description Study Design Arms and Interventions Outcome Measures Eligibility Criteria Contacts and Locations More Information

Responsible Party:	University of British Columbia
ClinicalTrials.gov Identifier:	NCT01498094 History of Changes
Other Study ID Numbers:	H11-03032
First Posted:	December 23, 2011
Last Update Posted:	May 12, 2015
Last Verified:	May 2015

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