Randomised controlled trial of oxygen therapy and high-flow nasal therapy in African children with pneumonia

Maitland, Kathryn; Kiguli, Sarah; Hamaluba, Mainga; Thomas, Karen; Alaroker, Florence; Opoka, RO; Tagoola, Abner; Bandika,; Mpoya, Ayub; Mnjella, Hellen; Nabawanuka, Eva; Okiror, William; Nakuya, Margaret; Aromut, Denis; Engoru, Charles; Oguda, Emmanuel; Td, Williams; Harrison, David A; Rowan, Kathy

doi:10.1007/s00134-021-06385-3

Cited by 46 publications

(56 citation statements)

References 32 publications

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“…The literature search yielded 12,176 records, and 146 proved potentially eligible. Of these, we excluded 125 studies (see Figure 1 ) and included 21 trials ( 11 – 18 , 29 – 41 ) with 5,342 children aged 19 days to 16 years. The literature search process is presented in Figure 1 and the network geometry is presented in Figure 2 .…”

Section: Resultsmentioning

confidence: 99%

“…In-Hospital Mortality Deaths were reported in only four studies (11,18,31,37) involving 2,014 participants. As shown in Figure 5A, there were no significant differences for mortality rate among the different treatments from NMA.…”

Section: Secondary Outcomementioning

confidence: 99%

“…However, this conventional meta-analysis only focused on head-to-head trials of comparison of two interventions without assessing multiple interventions as a whole. In addition, since the publication of this meta-analysis, several new randomized controlled trials (RCTs) have been published (11)(12)(13)(14)(15)(16)(17)(18). More importantly, there are no systematic reviews that have assessed the efficacy of BIPAP in pediatric patients.…”

Section: Introductionmentioning

confidence: 99%

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Non-Invasive Ventilation Strategies in Children With Acute Lower Respiratory Infection: A Systematic Review and Bayesian Network Meta-Analysis

Wang

Zhang

et al. 2021

Front. Pediatr.

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Background: Multiple non-invasive ventilation (NIV) modalities have been identified that may improve the prognosis of pediatric patients with acute lower respiratory infection (ALRI). However, the effect of NIV in children with ALRI remains inconclusive. Hence, this study aimed to evaluate the efficacy of various NIV strategies including continuous positive airway pressure (CPAP), high flow nasal cannula (HFNC), bilevel positive airway pressure (BIPAP), and standard oxygen therapy in children with ALRI and the need for supplemental oxygen.Methods: Embase, PubMed, Cochrane Library, and Web of Science databases were searched from inception to July 2021. Randomized controlled trials (RCTs) that compared different NIV modalities for children with ALRI and the need for supplemental oxygen were included. Data were independently extracted by two reviewers. Primary outcomes were intubation and treatment failure rates. Secondary outcome was in-hospital mortality. Pairwise and Bayesian network meta-analyses within the random-effects model were used to synthesize data. The certainty of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation framework.Results: A total of 21 RCTs involving 5,342 children were included. Compared with standard oxygen therapy, CPAP (OR: 0.40, 95% CrI: 0.16–0.90, moderate quality) was associated with a lower risk of intubation. Furthermore, both CPAP (OR: 0.42, 95% CrI: 0.19–0.81, low quality) and HFNC (OR: 0.51, 95% CrI: 0.29–0.81, low quality) reduced treatment failure compared with standard oxygen therapy. There were no significant differences among all interventions for in-hospital mortality. Network meta-regression showed that there were no statistically significant subgroup effects.Conclusion: Among children with ALRI and the need for supplemental oxygen, CPAP reduced the risk of intubation when compared to standard oxygen therapy. Both CPAP and HFNC were associated with a lower risk of treatment failure than standard oxygen therapy. However, evidence is still lacking to show benefits concerning mortality between different interventions. Further large-scale, multicenter studies are needed to confirm our results.Systematic Review Registration: https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=172156, identifier: CRD42020172156.

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Section: Resultsmentioning

confidence: 99%

Section: Secondary Outcomementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Non-Invasive Ventilation Strategies in Children With Acute Lower Respiratory Infection: A Systematic Review and Bayesian Network Meta-Analysis

Wang

Zhang

et al. 2021

Front. Pediatr.

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“…After the 5 th stoppage the TSC recommended the COAST oxygen trial to terminate, based on feasibility but recommended the COAST Nutrition trial to continue once the protocol had been amended (see relevant sections below). The results of the COAST oxygen trial have now been published as well as an editorial authored by members of the TSC 47 , 48 .…”

Section: Discussionmentioning

confidence: 99%

Children’s Oxygen Administration Strategies And Nutrition Trial (COAST-Nutrition): a protocol for a phase II randomised controlled trial

et al. 2021

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Background: To prevent poor long-term outcomes (deaths and readmissions) the integrated global action plan for pneumonia and diarrhoea recommends under the ‘Treat’ element of Protect, Prevent and Treat interventions the importance of continued feeding but gives no specific recommendations for nutritional support. Early nutritional support has been practiced in a wide variety of critically ill patients to provide vital cell substrates, antioxidants, vitamins, and minerals essential for normal cell function and decreasing hypermetabolism. We hypothesise that the excess post-discharge mortality associated with pneumonia may relate to the catabolic response and muscle wasting induced by severe infection and inadequacy of the diet to aid recovery. We suggest that providing additional energy-rich, protein, fat and micronutrient ready-to-use therapeutic feeds (RUTF) to help meet additional nutritional requirements may improve outcome. Methods: COAST-Nutrition is an open, multicentre, Phase II randomised controlled trial in children aged 6 months to 12 years hospitalised with suspected severe pneumonia (and hypoxaemia, SpO2 <92%) to establish whether supplementary feeds with RUTF given in addition to usual diet for 56-days (experimental) improves outcomes at 90-days compared to usual diet alone (control). Primary endpoint is change in mid-upper arm circumference (MUAC) at 90 days and/or as a composite with 90-day mortality. Secondary outcomes include anthropometric status, mortality, readmission at days 28 and 180. The trial will be conducted in four sites in two countries (Uganda and Kenya) enrolling 840 children followed up to 180 days. Ancillary studies include cost-economic analysis, molecular characterisation of bacterial and viral pathogens, evaluation of putative biomarkers of pneumonia, assessment of muscle and fat mass and host genetic studies. Discussion: This study is the first step in providing an option for nutritional support following severe pneumonia and will help in the design of a large Phase III trial. Registration: ISRCTN10829073 (6th June 2018) PACTR202106635355751 (2nd June 2021)

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“…In settings where intubation and mechanical ventilation are frequently unavailable, a decrease in need for intubation could conceivably translate to improvement in mortality. One study found that HFNC could decrease mortality in a model simulating scarce ventilators secondary to COVID-19 [ 84 ]; another study in children with hypoxemia in East Africa suggests that HFNC may confer a mortality benefit in that setting [ 85 ].…”

Section: Introductionmentioning

confidence: 99%

Promises and challenges of personalized medicine to guide ARDS therapy

et al. 2021

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Identifying new effective treatments for the acute respiratory distress syndrome (ARDS), including COVID-19 ARDS, remains a challenge. The field of ARDS investigation is moving increasingly toward innovative approaches such as the personalization of therapy to biological and clinical sub-phenotypes. Additionally, there is growing recognition of the importance of the global context to identify effective ARDS treatments. This review highlights emerging opportunities and continued challenges for personalizing therapy for ARDS, from identifying treatable traits to innovative clinical trial design and recognition of patient-level factors as the field of critical care investigation moves forward into the twenty-first century.

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Randomised controlled trial of oxygen therapy and high-flow nasal therapy in African children with pneumonia

Cited by 46 publications

References 32 publications

Non-Invasive Ventilation Strategies in Children With Acute Lower Respiratory Infection: A Systematic Review and Bayesian Network Meta-Analysis

Non-Invasive Ventilation Strategies in Children With Acute Lower Respiratory Infection: A Systematic Review and Bayesian Network Meta-Analysis

Children’s Oxygen Administration Strategies And Nutrition Trial (COAST-Nutrition): a protocol for a phase II randomised controlled trial

Promises and challenges of personalized medicine to guide ARDS therapy

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