Babies with bronchiolitis benefit from new oxygen therapy

Associate Professor Simon Craig

New research has shown that a new ‘high-flow’ oxygen therapy can be safely delivered to babies with bronchiolitis in emergency departments and general paediatrics wards in both large tertiary children’s hospitals and smaller regional centres.

The study, which compared traditional ‘low-flow’ oxygen to high-flow therapy in 1472 infants, found that the need to escalate care was less in those receiving high-flow.

Published last week in the New England Journal of Medicine, the study involved 17 hospitals across Australia and New Zealand, including researchers from Monash University, Monash Children’s Hospital, the Paediatric Critical Care Research Group (PCCRG) located at the Lady Cilento Children’s Hospital and the Paediatric Research in Emergency Departments International Collaborative (PREDICT). This collaboration makes it the largest paediatric study in this field worldwide.

Bronchiolitis—caused by a viral infection in the lungs—is the most common reason for infants under 12 months to be admitted to hospital, with 10 per cent of them requiring intensive care.

Study co-author Associate Professor Simon Craig from Monash University said the team found that high-flow oxygen therapy – a treatment which originated from intensive care units - was safe in the ward environment and led to less escalation of care. However, the study showed no difference in hospital length of stay, need for intensive care admission, or duration of oxygen therapy between the two treatment groups.

“We have demonstrated that stepping up to high-flow is safe in the ward environment,” said Associate Professor Craig, who is also a Monash Health paediatric emergency physician.

“Some children with bronchiolitis get sicker while in hospital. We’ve found that a therapy which was previously reserved for intensive care units can be delivered safely in emergency departments and on general paediatric wards,” Associate Professor Craig said.

“This means that we can reduce the number of infants and their families from regional areas who need to be relocated to one of the major cities for the duration of their illness.

“Relocating a family means they are unfamiliar with their surrounds and don’t have access to their usual support network.

“Most children with bronchiolitis don’t need high-flow therapy. However, it’s nice to know that – if they need it – we can do it safely outside of intensive care. This lets us keep children in their own community hospitals, reducing the impact on the child and the family,” Associate Professor Craig said.

High-flow nasal oxygen therapy works by delivering a higher volume of air and oxygen into the nasal passages to improve breathing.

The research was led by The University of Queensland Mater Research Institute (UQ-MRI) and Lady Cilento Children’s Hospital and funded by the National Health and Medical Research Council, the Emergency Medicine Foundation, the Mater Foundation and several Australian hospital foundations.