GOSH identify most effective breathing support for children

A trial comparing the types of breathing support given to children when they come off mechanical ventilation has found that using high flow nasal cannula therapy (HFNC), where oxygen is delivered through tubes into the nostrils, is not as effective as providing oxygen from a continuous positive airwave pressure (CPAP), where patients wear an oxygen mask.

The trial was led by Dr Ramnarayan, now Reader in Paediatric Critical care at Imperial College London, and was sponsored by Great Ormond Street Hospital for Children (GOSH).

600 children from newborn to age 15 were randomly assigned to move to HFNC following ventilation, and the other half to CPAP. HFNC is considered more comfortable for children to tolerate in comparison to CPAP, but research found that children on HFNC needed breathing support for up to 18 hours longer than those using CPAP. The study found that patients allocated CPAP could stop breathing support up to 30% faster than those allocated HFNC.

“We know that HFNC can’t deliver the same levels of breathing support as CPAP, but it’s been assumed that the reduced effectiveness is a price worth paying for the additional comfort it provides,” said Dr Ramnarayan. “Our results show that may not be the case.

“Most paediatricians have tended to prefer HFNC, but these results are likely to make them more cautious. While the choice of breathing support is specific to each patient, my own preference now is to start with CPAP, and if children struggle to tolerate it, only then to use HFNC as the next option.”

Professor Mark Peters, Consultant Paediatric Intensivist and Principle Investigator for GOSH, said: “This trial is just one of a series of fantastic collaborations between NHS Intensive Care Units that are improving the experience and outcomes for patients.”

Clinicians and researchers from GOSH, Imperial College Healthcare Trust, the Intensive Care National Audit & Research Centre, London School of Hygiene & Tropical Medicine, Birmingham Children’s Hospital, Bristol Children’s Hospital and the Universities of Leeds and Salford collaborated for the trial, which was funded by the National Institute for Health Research (NIHR).