High-flow nasal cannula therapy versus continuous positive airway pressure for non-invasive respiratory support in paediatric critical care: the FIRST-ABC RCTs
File(s)
Published version
Author(s)
Type
Journal Article
Abstract
Background
Despite the increasing use of non-invasive respiratory support in paediatric intensive care units, there are no large randomised controlled trials comparing two commonly used non-invasive respiratory support modes, continuous positive airway pressure and high-flow nasal cannula therapy.
Objective
To evaluate the non-inferiority of high-flow nasal cannula, compared with continuous positive airway pressure, when used as the first-line mode of non-invasive respiratory support in acutely ill children and following extubation, on time to liberation from respiratory support, defined as the start of a 48-hour period during which the child was free of respiratory support (non-invasive and invasive).
Design
A master protocol comprising two pragmatic, multicentre, parallel-group, non-inferiority randomised controlled trials (step-up and step-down) with shared infrastructure, including internal pilot and integrated health economic evaluation.
Setting
Twenty-five National Health Service paediatric critical care units (paediatric intensive care units and/or high-dependency units) across England, Wales and Scotland.
Participants
Critically ill children assessed by the treating clinician to require non-invasive respiratory support for (1) acute illness (step-up randomised controlled trial) or (2) within 72 hours of extubation (step-down randomised controlled trial).
Interventions
High-flow nasal cannula delivered at a flow rate based on patient weight (Intervention) compared to continuous positive airway pressure of 7–8 cm H2O pressure (Control).
Despite the increasing use of non-invasive respiratory support in paediatric intensive care units, there are no large randomised controlled trials comparing two commonly used non-invasive respiratory support modes, continuous positive airway pressure and high-flow nasal cannula therapy.
Objective
To evaluate the non-inferiority of high-flow nasal cannula, compared with continuous positive airway pressure, when used as the first-line mode of non-invasive respiratory support in acutely ill children and following extubation, on time to liberation from respiratory support, defined as the start of a 48-hour period during which the child was free of respiratory support (non-invasive and invasive).
Design
A master protocol comprising two pragmatic, multicentre, parallel-group, non-inferiority randomised controlled trials (step-up and step-down) with shared infrastructure, including internal pilot and integrated health economic evaluation.
Setting
Twenty-five National Health Service paediatric critical care units (paediatric intensive care units and/or high-dependency units) across England, Wales and Scotland.
Participants
Critically ill children assessed by the treating clinician to require non-invasive respiratory support for (1) acute illness (step-up randomised controlled trial) or (2) within 72 hours of extubation (step-down randomised controlled trial).
Interventions
High-flow nasal cannula delivered at a flow rate based on patient weight (Intervention) compared to continuous positive airway pressure of 7–8 cm H2O pressure (Control).
Date Issued
2025-05-01
Date Acceptance
2025-04-01
Citation
Health Technology Assessment, 2025, 29 (9)
ISSN
1366-5278
Publisher
NIHR Journals Library
Journal / Book Title
Health Technology Assessment
Volume
29
Issue
9
Copyright Statement
Copyright © 2025 Ramnarayan et al. This work was produced by Ramnarayan et al. under the terms of a commissioning contract issued by the Secretary of State for Health and Social Care. This is an Open Access publication distributed under the terms of the Creative Commons Attribution CC BY 4.0 licence, which permits unrestricted use, distribution, reproduction and adaptation in any medium and for any purpose provided that it is properly attributed. See: https://creativecommons.org/licenses/by/4.0/. For attribution the title, original author(s), the publication source – NIHR Journals Library, and the DOI of the publication must be cited.
License URL
Identifier
https://www.ncbi.nlm.nih.gov/pubmed/40326538
Subjects
ACUTE VIRAL BRONCHIOLITIS
CHILDREN
COHORT
COST-EFFECTIVENESS ANALYSIS
FEASIBILITY
Health Care Sciences & Services
Life Sciences & Biomedicine
MECHANICAL VENTILATION
MEDICINE
PEDSQL(TM)
RANDOMIZED CONTROLLED-TRIAL
Science & Technology
YOUNG INFANTS
Publication Status
Published
Coverage Spatial
England
Article Number
PDBG1495
Date Publish Online
2025-05-01