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PARIS-2 RCT – Does High Flow Oxygen Help Hypoxic Children?

February 16, 2023

Written by Chris Thom

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As compared with standard oxygen therapy, high flow oxygen was associated with increased length of hospital stay in pediatric patients with hypoxemic respiratory failure.

Why does this matter?
High flow oxygen therapy has gained enthusiasm as a therapy for infants with bronchiolitis. The role of this therapy in children aged 1 to 4 years with hypoxemic respiratory failure is unclear. Does high flow oxygen therapy provide benefit in this population?

Slow and steady won the raceā€¦.
This was a RCT at 14 hospitals enrolling patients aged 1 to 4 years with hypoxemic respiratory failure. Inclusion criteria were children with all four of the following: increased work in breathing, oxygen requirement, increased respiratory rate, and need for inpatient admission. Diagnoses primarily included reactive airway disease, pneumonia, pneumonitis, viral-induced wheeze, and bronchiolitis. 1,567 patients were randomized, 782 to receive high flow oxygen and 785 to receive standard oxygen. High flow oxygen used the AIRVO-2 high-flow system while standard oxygen used a nasal cannula or face mask.

The length of hospital stay was a median of 1.77 days (IQR 1.03-2.8) in the high flow group and 1.50 days (IQR 0.85-2.44) in the standard oxygen group, which was statistically significant. 12.5% in the high flow group required escalation to the ICU, compared to 6.9% in the standard oxygen group, OR 1.93 (95%CI 1.35-2.75).

Importantly, there was a high rate of crossover in both arms, with 323 patients in the high flow arm receiving standard oxygen at some point and 141 patients in the standard oxygen arm receiving some high flow oxygen. In an analysis of only patients who remained in their randomized arm, the increase in length of stay and ICU admission rate was still present for the high flow group.

High flow oxygen did not provide benefit to this cohort of patients and was inferior to standard oxygen for the primary study outcome.

Effect of Early High-Flow Nasal Oxygen vs Standard Oxygen Therapy on Length of Hospital Stay in Hospitalized Children With Acute Hypoxemic Respiratory Failure: The PARIS-2 Randomized Clinical Trial. JAMA. 2023;329(3):224-234.

What are your thoughts?