High Flow Nasal Cannula Versus Conventional Oxygen Therapy and Incidence of Post-Extubation Airway Obstruction in PICU: An Open-Label Randomized Controlled Trial (HiFloCOT-PICU Trial).

IF 2 4区 医学 Q2 PEDIATRICS
Indian Journal of Pediatrics Pub Date : 2025-10-01 Epub Date: 2024-08-05 DOI:10.1007/s12098-024-05228-5
K C Sudeep, Suresh Kumar Angurana, Karthi Nallasamy, Arun Bansal, Muralidharan Jayashree
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引用次数: 0

Abstract

Objectives: To study the impact of high flow nasal cannula (HFNC) vs. conventional oxygen therapy (COT) (by simple nasal cannula) as respiratory support after extubation on the rates of post-extubation airway obstruction (PEAO) among mechanically ventilated critically ill children.

Methods: This open-label randomized controlled trial was conducted in pediatric intensive care unit (PICU) of a tertiary care teaching hospital in North India over a period of 7 mo (11 August 2021 to 10 March 2022). Children aged 3 mo to 12 y who required invasive mechanical ventilation for > 72 h and had passed spontaneous breathing trial (ready for extubation) were enrolled and randomized by computer generated block randomization to receive HFNC or COT after extubation. Primary outcome was rate of PEAO (assessed by modified Westley croup score, mWCS) within 48 h of extubation; and secondary outcomes were rate and number of adrenaline nebulization, treatment failure (requiring escalation of respiratory support), extubation failure, adverse events, and length of PICU stay in two groups.

Results: During the study period, 116 children were enrolled (58 each in HFNC and COT groups). There was no difference in rate of PEAO (55% vs. 51.7%, respectively), need of adrenaline nebulization, extubation failure, adverse events, and duration of PICU stay in two groups. However, the HFNC group had significantly lower rates of treatment failure (27.6% vs. 48.3%, p = 0.02).

Conclusions: The rate of PEAO was similar in HFNC and COT groups. However, HFNC group had significantly lower rate of treatment failure requiring escalation of respiratory support.

Abstract Image

高流量鼻导管与传统氧气疗法以及 PICU 拔管后气道阻塞的发生率:一项开放标签随机对照试验(HiFloCOT-PICU 试验)。
研究目的研究高流量鼻插管(HFNC)与传统氧疗(COT)(通过简单鼻插管)作为拔管后呼吸支持对机械通气重症儿童拔管后气道阻塞(PEAO)发生率的影响:这项开放标签随机对照试验在印度北部一家三级教学医院的儿科重症监护室(PICU)进行,为期 7 个月(2021 年 8 月 11 日至 2022 年 3 月 10 日)。需要有创机械通气超过 72 小时且已通过自主呼吸试验(准备拔管)的 3 个月至 12 岁儿童被纳入试验,并通过计算机生成的区组随机法随机分配在拔管后接受 HFNC 或 COT。主要结果是拔管后 48 小时内 PEAO 的发生率(通过改良韦斯特利哮鸣评分 mWCS 评估);次要结果是两组肾上腺素雾化的发生率和次数、治疗失败(需要升级呼吸支持)、拔管失败、不良事件和 PICU 住院时间:在研究期间,共有 116 名儿童入组(HFNC 组和 COT 组各 58 名)。两组的 PEAO 发生率(分别为 55% 和 51.7%)、肾上腺素雾化需求、拔管失败、不良事件和 PICU 留院时间均无差异。然而,HFNC 组的治疗失败率明显较低(27.6% 对 48.3%,P = 0.02):结论:HFNC 组和 COT 组的 PEAO 发生率相似。结论:HFNC 组和 COT 组的 PEAO 发生率相似,但 HFNC 组需要升级呼吸支持的治疗失败率明显较低。
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来源期刊
Indian Journal of Pediatrics
Indian Journal of Pediatrics 医学-小儿科
CiteScore
8.10
自引率
7.00%
发文量
394
审稿时长
3-6 weeks
期刊介绍: Indian Journal of Pediatrics (IJP), is an official publication of the Dr. K.C. Chaudhuri Foundation. The Journal, a peer-reviewed publication, is published twelve times a year on a monthly basis (January, February, March, April, May, June, July, August, September, October, November, December), and publishes clinical and basic research of all aspects of pediatrics, provided they have scientific merit and represent an important advance in knowledge. The Journal publishes original articles, review articles, case reports which provide new information, letters in relation to published articles, scientific research letters and picture of the month, announcements (meetings, courses, job advertisements); summary report of conferences and book reviews.
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