Bronchiolitis in infants is the leading cause of paediatric hospitalisation in Australia accounting for approximately 8000 admissions annually, of which approximately 500-600 are admitted to a paediatric intensive care unit (PICU) requiring respiratory support. None of the current treatments have successfully changed the outcome of the disease or the burden on health care systems. High flow nasal cannula (HFNC) therapy has been used over the last few years in paediatrics with reports showing a reduction in the need for non-invasive and invasive respiratory support.
HFNC reduces the work of breathing, improves the gas exchange and can be applied very early in the disease process as there is little inference with the patients comfort. There has been no “best practice” and many centres do not use the HFNC for bronchiolitis as there are opposing reports about its benefit and a lack of consensus on how to use it. This study aims to develop a multi-centre trial and to assess which patients with bronchiolitis benefit using HFNC.
In an earlier pilot study, the team found the use of HFNC therapy in PICUs significantly reduced the need for invasive ventilation and intubation, with a 40% reduced PICU admission rate, a 2.5 times reduction in intubation. They also showed the use of HFNC therapy in a paediatric ward was safe and delivered high quality care for infants with bronchiolitis. They also showed that infants <2 years of age could be safely transported on HFNC to tertiary facilities.
This EMF-funded trial was rolled into a much larger NHMRC-funded multi-site trial, run across 17 hospitals in Australia and New Zealand (http://www.predict.org.au/projects/nasal-cannula/). Recruitment for this trial was completed in late 2016, with the data expected to be published towards the end of 2017.
- £ 4.3 million from Medical Research Council (UK)
- $1.3 million from NHMRC
- $200,000 top-up funding from The University of Queensland
- In-kind support by Fisher & Paykel, who provided high-flow equipment at no-charge for this trial and the NHMRC-funded clinical trial
> Franklin, D., Dalziel, S., Schlapbach, L.J., Babl, F.E., Oakley, E., Craig, S.S., Furyk, J.S., Neutze, J., Sinn, K., Whitty, J.A. and Gibbons, K., 2015. Early high flow nasal cannula therapy in bronchiolitis, a prospective randomised control trial (protocol): A Paediatric Acute Respiratory Intervention Study (PARIS). BMC pediatrics, 15(1), p.1.
> PowerPoint presentation: https://children.wcha.asn.au/sites/default/files/paris_-_high_flow_trial_-_bronchiolitis_-_andreas_schibler_lady_cilento_childrens_hospital.pdf
Dr Christa Bell
A/Prof Andreas Schibler
Dr Kylie Baker
Mrs Kelly Foster