Heated Humidified Oxygen Compared to Dry Oxygen Therapy in Children With Bronchiolitis

Not Applicable

Completed

Brief Summary: The purpose of this study is to compare heat and humidified oxygen with cold and dry oxygen in children with bronchiolitis.

The hypotheses are that heating and humidifying inspired low flow supplemental oxygen will optimize mucociliary function thereby, 1) improve oxygenation, 2) decrease work of breathing, and 3) decrease length of hospital stay.

Detailed Description: Bronchiolitis is the leading cause of acute respiratory illness and hospitalization in infants and young children. The mainstay of treatment is supportive care, which includes frequent nasal suctioning, intravenous fluid hydration, and supplemental oxygen for hypoxemia.

The airways normally heat and humidify inspired ambient air to core temperature amd 100% relative humidity at the carina. This environment, at core temperature, allows for optimal mucociliary clearance. Supplemental oxygen delivered via wall source is cold and dry, and does not reach core temperature and 100% humidity until some point distal to the carina, past the main bronchi. This presses on the lower respiratory tract to assist in heat and moisture exchange and thus decrease ciliary function. This, in combination with bronchiolitis, can impair mucociliary clearance.

Specific aim 1: Determine the effect of heated and humidified oxygen therapy on clinical improvement in children with bronchiolitis, based on Respiratory Distress Assessment Instrument (RDAI) and respiratory rate (RR).

Specific aim 2: Determine the effect of heated and humidified oxygen therapy on length of hospital stay and duration of supplemental oxygen requirement in children with bronchiolitis.

Recruitment & Eligibility

Inclusion Criteria

Ages ≤24 months of age
Physician diagnosed bronchiolitis
Admitted to pediatric floor
Supplemental oxygen requirement, <4 L/min, for hypoxemia, oxygen saturation <92% in room air

Exclusion Criteria

Prematurity, born <37 weeks gestational age
Admitted to pediatric intensive care unit for medical indication
Requirement of heated, humidified high flow system
Chronic lung disease (such as bronchopulmonary dysplasia, cystic fibrosis, primary ciliary dyskinesia, tracheostomy status, baseline oxygen requirement)
Neuromuscular disorders
Chromosomal defects
Metabolic disorders
Immunodeficiency
Unrepaired cardiac abnormalities

Arm && Interventions

Group	Intervention	Description
Heated and humidified oxygen	Heated and humidified oxygen	Heated and humified oxygen

Primary Outcome Measures

Name	Time	Method
Change in Respiratory Distress Assessment Instrument (RDAI) From Baseline.	Baseline, Hour 1, Hour 4, Hour 8, and Hour 12	The RDAI is a validated clinical scoring system to assess respiratory distress and has been used in several bronchiolitis studies. The RDAI is based on two variables, wheezing and retractions, in which points are applied to each to give a score ranging from 0 to 17. The higher the total score, the worse the subject was clinically. Reported are the absolute scores at each time point, for each arm. Baseline scores are reported in the Baseline Module.
Change in Respiratory Rate (RR) From Baseline	Baseline, Hour 1, Hour 4, Hour 8, and Hour 12	Respiratory rate was measured by counting respirations for one minute. Reported are the absolute scores at each time point, for each arm. Baseline scores are reported in the Baseline Module.

Secondary Outcome Measures

Name	Time	Method
Length of Hospital Stay	Subjects will be followed for the duration of hospital stay until discharge	Length of hospital stay is measured in days and counted from day of admission to day of discharge.
Duration of O2 Use	Subjects will be followed for the duration of oxygen requirement until oxygen discontinued	Duration on supplemental O2 was measured in hours.