The PREDICT position paper on the use of high flow in infants with bronchiolitis Over the past 5 years, the use of high flow in infants with bronchiolitis has significantly increased, particularly outside of an ICU setting. Whilst we are not entirely sure how high flow works, it is believed that it: - aids mucociliary clearance of secretions - washes out physiological dead space - provides a small amount of PEEP to reverse and prevent small airway collapse The PARIS trial published in 2018 showed that in hypoxic infants with bronchiolitis, those commenced on high flow were less likely to require escalation in therapy than those initially managed with low flow oxygen. It also demonstrated that very few infants managed with high flow developed complications as a result. This is all very useful, but how do we decide when to commence high flow in our own patients? This recent position paper from the PREDICT group (who also wrote the Australasian bronchiolitis guideline) is a systematic review of 4 randomised controlled trials where infants with bronchiolitis were managed with high flow. They conclude, based on the current evidence, that: - High flow should be used as rescue treatment for hypoxic infants who have not responded to low flow therapy (suggesting a 4hr trial) - In patients who are not hypoxic but have severe disease, the use of high flow is not currently supported by evidence and should only be considered in the context of a research trial or an ICU environment Will this change your practice? Dr Danielle Scarfe
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October 2021
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