High-flow nasal oxygen in infants and children for early respiratory management of pneumonia-induced acute hypoxemic respiratory failure: the CENTURI randomized clinical trial

Sasidaran Kandasamy; Ramachandran Rameshkumar; Thangavelu Sangaralingam; Nedunchelian Krishnamoorthy; N C Gowri Shankar; Vimalraj Vijayakumar; Balaji Sridharan

doi:10.1007/s44253-024-00031-8

High-flow nasal oxygen in infants and children for early respiratory management of pneumonia-induced acute hypoxemic respiratory failure: the CENTURI randomized clinical trial

Intensive Care Med Paediatr Neonatal. 2024;2(1):15. doi: 10.1007/s44253-024-00031-8. Epub 2024 Apr 1.

Authors

Sasidaran Kandasamy¹, Ramachandran Rameshkumar^{2

3}, Thangavelu Sangaralingam⁴, Nedunchelian Krishnamoorthy⁵, N C Gowri Shankar⁴, Vimalraj Vijayakumar⁶, Balaji Sridharan⁷

Affiliations

¹ Advanced Pediatric Critical Care Centre, Pediatric Acute Care Education & Research (PACER) Unit, Department of Pediatrics, Mehta Multi Speciality Hospitals, Chennai, Tamil Nadu 600 031 India.
² Division of Pediatric Critical Care, Department of Pediatrics, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, 605 006 India.
³ Present Address: Pediatric Critical Care, Mediclinic City Hospital, Mohammed Bin Rashid University of Medicine and Health Sciences (MBRU), Dubai, United Arab Emirates.
⁴ Department of Pediatrics, Mehta Multi Speciality Hospitals, Chennai, Tamil Nadu 600 031 India.
⁵ Department of Research & Academics, Mehta Multi Speciality Hospitals, Chennai, Tamil Nadu 600 031 India.
⁶ Advanced Pediatric Critical Care Centre, Department of Pediatrics, Mehta Multi Speciality Hospitals, Chennai, Tamil Nadu 600 031 India.
⁷ Pediatric Acute Care Education and Research (PACER) Unit, Department of Pediatrics, Mehta Multi-Speciality Hospitals, Chennai, Tamil Nadu 600 031 India.

Abstract

Objective: To compare the effectiveness of early high-flow nasal cannula (HFNC) and low-flow oxygen support (LFOS) in children under 5 years with acute hypoxemic respiratory failure (AHRF) due to severe community-acquired pneumonia in low-middle-income countries.

Methods: An open-label randomized clinical trial enrolled children aged 2-59 months with AHRF due to severe community-acquired pneumonia and randomized into HFNC and LFOS. In the LFOS group, the patient received cold wall oxygen humidified by bubbling through sterile water administered through simple nasal prongs at a fixed flow rate of 2 L/min. In the HFNC group, the patient received humidified, heated (37 °C), high-flow oxygen at a flow rate assigned based on weight range, with a titratable oxygen fraction. The primary outcome was treatment failure in 72 h (escalating the respiratory support method using any modality other than primary intervention).

Results: Data was analyzed intention-to-treat (HFNC = 124; LFOS = 120). Median (IQR) age was 12 (6-20) and 11 (6-27) months, respectively. Treatment failure occurred in a significantly lower proportion in the HFNC group (7.3%, n = 9/124) as compared to the LFOS group (20%, n = 24/120) (relative risk = 0.36, 95% CI 0.18 to 0.75; p = 0.004; adjusted hazard ratio 0.34, 95% CI 0.16 to 0.73; p = 0.006). The intubation rate was significantly lower in the HFNC group (7.3%, n = 9/124 vs. 16.7%, n = 20/120; relative risk = 0.44, 95% CI 0.21 to 0.92, p = 0.023). There were no significant differences noted in other secondary outcomes. No mortality occurred.

Conclusion: High-flow nasal cannula oxygen therapy used as early respiratory support in children under 5 years with acute hypoxemic respiratory failure due to severe community-acquired pneumonia was associated with significantly lower treatment failure compared with standard low-flow oxygen support.

Trial registration: CTRI/2016/04/006788. Registered 01 April 2016, https://ctri.nic.in/Clinicaltrials/advsearch.php.

Supplementary information: The online version contains supplementary material available at 10.1007/s44253-024-00031-8.

Keywords: Children; Mechanical ventilation; Pneumonia; Respiratory support.