The results of the prospective, multi-center randomized controlled trial were published by Franklin and colleagues in March 2018 in New England Journal of Medicine titled A Randomized Trial of High-Flow Oxygen Therapy in Infants with Bronchiolitis. The trial found among infants with bronchiolitis, those treated with high flow nasal cannula (HFNC) had significantly lower rates of escalation of care due to treatment failure than those treated with standard Oxygen therapy. Children randomized to HFNC required escalation 12% of the time, while those randomized to standard oxygen therapy required escalation 23% of the time (difference -11%, 95%CI -15 to -7%, p<0.001). Less than 1% of infants in the trial required intubation.
This is the largest prospective randomized controlled trial in this patient population with a total of 1,472 infants enrolled. These findings are supported by the results of a smaller clinical trial that showed a lower treatment failure rate in the HFNC group than the standard oxygen group (14% vs. 33%).1 The results confirm safety and efficacy of HFNC as a viable first-line therapy for treating bronchiolitis.
Bronchiolitis is the leading cause of hospitalization in infants and young children and is responsible for $1.7 billion in hospitalization costs in the United States.2,3This study demonstrates the ability to use HFNC outside the ICU, which may reduce the cost of care, and generally be more comfortable and convenient for the family.
A noteworthy insight of the methods of the trial is that HFNC was delivered at a flow rate of 2 L/kg/min, with an average starting flow of approximately 14 L/min. There is a large body of clinical evidence to support the use of high starting flow rates for infants.4,5,6
For hospitals using Vapotherm high velocity therapy, it’s worth noting that these findings on HFNC could be extrapolated. Although Vapotherm high velocity therapy is a mask-free form of noninvasive ventilation, its primary mechanism of action is flush, not pressure. A smaller randomized controlled trial conducted with Vapotherm high velocity therapy recommends that modality as a front line tool for bronchiolitis.