{"id":23393,"date":"2023-02-17T04:17:00","date_gmt":"2023-02-16T20:17:00","guid":{"rendered":"http:\/\/csccm.org.cn\/?p=23393"},"modified":"2023-02-17T06:09:57","modified_gmt":"2023-02-16T22:09:57","slug":"jama%e5%8f%91%e8%a1%a8%e8%ae%ba%e6%96%87%ef%bc%9a%e6%97%a9%e6%9c%9f%e9%ab%98%e6%b5%81%e9%87%8f%e6%b0%a7%e7%96%97%e4%b8%8e%e6%a0%87%e5%87%86%e6%b0%a7%e7%96%97%e5%af%b9%e6%80%a5%e6%80%a7%e4%bd%8e","status":"publish","type":"post","link":"https:\/\/csccm.org.cn\/?p=23393","title":{"rendered":"[JAMA\u53d1\u8868\u8bba\u6587]\uff1a\u65e9\u671f\u9ad8\u6d41\u91cf\u6c27\u7597\u4e0e\u6807\u51c6\u6c27\u7597\u5bf9\u6025\u6027\u4f4e\u6c27\u6027\u547c\u5438\u529f\u80fd\u8870\u7aed\u60a3\u513f\u4f4f\u9662\u65e5\u7684\u5f71\u54cd"},"content":{"rendered":"\n

Original Investigation <\/p>\n\n\n\n

Caring for the Critically Ill Patient<\/p>\n\n\n\n

January 17, 2023<\/p>\n\n\n\n

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<\/h1>\n\n\n\n

Donna\u00a0Franklin,\u00a0Franz E.\u00a0Babl,\u00a0Shane\u00a0George,\u00a0et al<\/h3>\n\n\n\n

JAMA.\u00a0<\/em>2023;329(3):224-234. doi:10.1001\/jama.2022.21805<\/h3>\n\n\n\n

Key Points<\/p>\n\n\n\n

Question<\/strong>  Does the early use of nasal high-flow oxygen therapy in children aged 1 to 4 years with acute hypoxemic respiratory failure reduce the length of hospital stay compared with standard oxygen therapy?<\/p>\n\n\n\n

Findings<\/strong>  In this randomized clinical trial that included 1567 children with acute hypoxemic respiratory failure, use of nasal high-flow oxygen therapy resulted in a median hospital stay of 1.77 days compared with 1.50 days in the standard oxygen therapy group, a difference that was statistically significant.<\/p>\n\n\n\n

Meaning<\/strong>  Early use of nasal high-flow oxygen therapy in children aged 1 to 4 years with acute hypoxemic respiratory failure did not reduce the length of hospital stay compared with standard oxygen therapy.<\/a><\/p>\n\n\n\n

Abstract<\/p>\n\n\n\n

Importance<\/strong>  Nasal high-flow oxygen therapy in infants with bronchiolitis and hypoxia has been shown to reduce the requirement to escalate care. The efficacy of high-flow oxygen therapy in children aged 1 to 4 years with acute hypoxemic respiratory failure without bronchiolitis is unknown.<\/p>\n\n\n\n

Objective<\/strong>  To determine the effect of early high-flow oxygen therapy vs standard oxygen therapy in children with acute hypoxemic respiratory failure.<\/p>\n\n\n\n

Design, Setting, and Participants<\/strong>  A multicenter, randomized clinical trial was conducted at 14 metropolitan and tertiary hospitals in Australia and New Zealand, including 1567 children aged 1 to 4 years (randomized between December 18, 2017, and March 18, 2020) requiring hospital admission for acute hypoxemic respiratory failure. The last participant follow-up was completed on March 22, 2020.<\/p>\n\n\n\n

Interventions<\/strong>  Enrolled children were randomly allocated 1:1 to high-flow oxygen therapy (n\u2009=\u2009753) or standard oxygen therapy (n\u2009=\u2009764). The type of oxygen therapy could not be masked, but the investigators remained blinded until the outcome data were locked.<\/p>\n\n\n\n

Main Outcomes and Measures<\/strong>  The primary outcome was length of hospital stay with the hypothesis that high-flow oxygen therapy reduces length of stay. There were 9 secondary outcomes, including length of oxygen therapy and admission to the intensive care unit. Children were analyzed according to their randomization group.<\/p>\n\n\n\n

Results<\/strong>  Of the 1567 children who were randomized, 1517 (97%) were included in the primary analysis (median age, 1.9 years [IQR, 1.4-3.0 years]; 732 [46.7%] were female) and all children completed the trial. The length of hospital stay was significantly longer in the high-flow oxygen group with a median of 1.77 days (IQR, 1.03-2.80 days) vs 1.50 days (IQR, 0.85-2.44 days) in the standard oxygen group (adjusted hazard ratio, 0.83 [95% CI, 0.75-0.92]; P<\/em>\u2009<\u2009.001). Of the 9 prespecified secondary outcomes, 4 showed no significant difference. The median length of oxygen therapy was 1.07 days (IQR, 0.50-2.06 days) in the high-flow oxygen group vs 0.75 days (IQR, 0.35-1.61 days) in the standard oxygen therapy group (adjusted hazard ratio, 0.78 [95% CI, 0.70-0.86]). In the high-flow oxygen group, there were 94 admissions (12.5%) to the intensive care unit compared with 53 admissions (6.9%) in the standard oxygen group (adjusted odds ratio, 1.93 [95% CI, 1.35-2.75]). There was only 1 death and it occurred in the high-flow oxygen group.<\/p>\n\n\n\n

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Conclusions and Relevance<\/strong>  Nasal high-flow oxygen used as the initial primary therapy in children aged 1 to 4 years with acute hypoxemic respiratory failure did not significantly reduce the length of hospital stay compared with standard oxygen therapy.<\/p>\n\n\n\n

Trial Registration<\/strong>  anzctr.org.au Identifier: ACTRN12618000210279<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"

Original Investigation  Caring for the Critically […]<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":[],"categories":[32,23],"tags":[],"_links":{"self":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/23393"}],"collection":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=23393"}],"version-history":[{"count":1,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/23393\/revisions"}],"predecessor-version":[{"id":23394,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/23393\/revisions\/23394"}],"wp:attachment":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=23393"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=23393"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=23393"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}