Queensland study to revolutionise treatment of children with bronchiolitis

Friday 23 March 2018

A landmark Queensland-led study into the emergency care and management of infants with bronchiolitis is set to change the way the disease is treated in hospitals internationally.

Researchers at Mater Research Institute - The University of Queensland (MRI-UQ) and Lady Cilento Children’s Hospital found that nasal high-flow therapy halved the number of children requiring a higher level of care, including intensive care, for bronchiolitis. 

Bronchiolitis – caused by a viral infection in the lungs – is the most common reason for infants under 12 months to be admitted to hospital, with 10 per cent of them requiring intensive care.

The three-year international study involved 1472 infants who presented at emergency departments across 17 hospitals in Australia and New Zealand.  

Approximately 20 per cent of all non-elective intensive care admissions for children in Australia and New Zealand are due to bronchiolitis, accounting for more than AU$40 million in intensive care costs alone each year.

Mater Researcher and Lady Cilento Children’s Hospital paediatric intensivist, Associate Professor Andreas Schibler, said the findings would be a game changer.

“Nasal high-flow therapy works by delivering a higher volume of air and oxygen into the nasal passages than standard-oxygen delivery methods. This results in more efficient delivery of oxygen to the airways and reduces the work of breathing for the infants affected.

“The aim of the study was to investigate if early use of nasal high flow therapy could reduce the need to escalate care in infants with bronchiolitis. The answer to this question was ‘yes’,” Associate Professor Schibler said.

“In fact, the study found that nasal high-flow therapy reduced the need for escalation of care by half - from 23 per cent in standard-oxygen delivery to 12 per cent for infants receiving nasal high-flow therapy.”

UQ-MRI PhD student Donna Franklin said the study would change standard practice for caring and managing infants with bronchiolitis.

“This study found that a therapy which was previously reserved for intensive care units could be delivered safely in emergency departments and on general paediatric wards in a hospital,” Ms Franklin said.

“This will reduce the number of infants and their families from regional areas who need to be relocated to one of the major cities for the duration of their illness.

“Relocating a family means they are unfamiliar with their surrounds and don’t have access to their usual support network.

“Introducing high-flow oxygen therapy early in the illness means we can keep children in their own community hospitals, reducing the impact on the child and the family.”

The research, published in the New England Journal of Medicine, was funded by Mater Foundation and several Australian hospital foundations, the National Health and Medical Research Council and the Emergency Medicine Foundation.

It involved researchers from the Murdoch Children’s Research Institute, the Royal Children’s Hospital Melbourne, the University of Melbourne, the Paediatric Critical Care Research Group at the Lady Cilento Children’s Hospital and the Paediatric Research in Emergency Departments International Collaborative.

“It’s basically a plague during the winter months. Intensive care beds are filled up with infants with bronchiolitis and we have shown that we can reduce that number quite significantly.”