High-flow nasal oxygen in infants and children for early respiratory management of pneumonia-induced acute hypoxemic respiratory failure: the CENTURI randomized clinical trial.

Autor: Kandasamy S; Advanced Pediatric Critical Care Centre, Pediatric Acute Care Education & Research (PACER) Unit, Department of Pediatrics, Mehta Multi Speciality Hospitals, Chennai, Tamil Nadu 600 031 India., Rameshkumar R; Division of Pediatric Critical Care, Department of Pediatrics, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, 605 006 India.; Present Address: Pediatric Critical Care, Mediclinic City Hospital, Mohammed Bin Rashid University of Medicine and Health Sciences (MBRU), Dubai, United Arab Emirates., Sangaralingam T; Department of Pediatrics, Mehta Multi Speciality Hospitals, Chennai, Tamil Nadu 600 031 India., Krishnamoorthy N; Department of Research & Academics, Mehta Multi Speciality Hospitals, Chennai, Tamil Nadu 600 031 India., Shankar NCG; Department of Pediatrics, Mehta Multi Speciality Hospitals, Chennai, Tamil Nadu 600 031 India., Vijayakumar V; Advanced Pediatric Critical Care Centre, Department of Pediatrics, Mehta Multi Speciality Hospitals, Chennai, Tamil Nadu 600 031 India., Sridharan B; Pediatric Acute Care Education and Research (PACER) Unit, Department of Pediatrics, Mehta Multi-Speciality Hospitals, Chennai, Tamil Nadu 600 031 India.
Jazyk: angličtina
Zdroj: Intensive care medicine. Paediatric and neonatal [Intensive Care Med Paediatr Neonatal] 2024; Vol. 2 (1), pp. 15. Date of Electronic Publication: 2024 Apr 01.
DOI: 10.1007/s44253-024-00031-8
Abstrakt: Objective: To compare the effectiveness of early high-flow nasal cannula (HFNC) and low-flow oxygen support (LFOS) in children under 5 years with acute hypoxemic respiratory failure (AHRF) due to severe community-acquired pneumonia in low-middle-income countries.
Methods: An open-label randomized clinical trial enrolled children aged 2-59 months with AHRF due to severe community-acquired pneumonia and randomized into HFNC and LFOS. In the LFOS group, the patient received cold wall oxygen humidified by bubbling through sterile water administered through simple nasal prongs at a fixed flow rate of 2 L/min. In the HFNC group, the patient received humidified, heated (37 °C), high-flow oxygen at a flow rate assigned based on weight range, with a titratable oxygen fraction. The primary outcome was treatment failure in 72 h (escalating the respiratory support method using any modality other than primary intervention).
Results: Data was analyzed intention-to-treat (HFNC = 124; LFOS = 120). Median (IQR) age was 12 (6-20) and 11 (6-27) months, respectively. Treatment failure occurred in a significantly lower proportion in the HFNC group (7.3%, n  = 9/124) as compared to the LFOS group (20%, n  = 24/120) (relative risk = 0.36, 95% CI 0.18 to 0.75; p  = 0.004; adjusted hazard ratio 0.34, 95% CI 0.16 to 0.73; p  = 0.006). The intubation rate was significantly lower in the HFNC group (7.3%, n  = 9/124 vs. 16.7%, n  = 20/120; relative risk = 0.44, 95% CI 0.21 to 0.92, p  = 0.023). There were no significant differences noted in other secondary outcomes. No mortality occurred.
Conclusion: High-flow nasal cannula oxygen therapy used as early respiratory support in children under 5 years with acute hypoxemic respiratory failure due to severe community-acquired pneumonia was associated with significantly lower treatment failure compared with standard low-flow oxygen support.
Trial Registration: CTRI/2016/04/006788. Registered 01 April 2016, https://ctri.nic.in/Clinicaltrials/advsearch.php.
Supplementary Information: The online version contains supplementary material available at 10.1007/s44253-024-00031-8.
Competing Interests: Competing interestsThe authors declare no competing interests.
(© The Author(s) 2024.)
Databáze: MEDLINE
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