CENTURI
Trial question
What is the role of high-flow nasal cannula oxygen therapy in pediatric patients with pneumonia-induced acute hypoxemic respiratory failure?
Study design
Single center
Open label
RCT
Population
Characteristics of study participants
34.0% female
66.0% male
N = 244
244 patients (83 female, 161 male)
Inclusion criteria: children, aged 2-59 months, with acute hypoxemic respiratory failure due to severe community-acquired pneumonia
Key exclusion criteria: chronic lung disease; asthma; empyema; neuromuscular disease; hospitalization in the past 30 days; receipt of home ventilation or oxygen support; congenital cardiac or other multiple malformations
Interventions
N=124 high-flow nasal cannula (high-flow oxygen started at a flow rate of 2 L/kg/min if weight ≤ 10 kg, 20 L + 0.5 L/kg for each kg if weight > 10 kg, administered through Optiflow™ nasal cannula)
N=120 low-flow oxygen support (a fixed oxygen flow rate of 2 L/min administered through simple nasal prongs)
Primary outcome
Treatment failure in 72 hours
7.3
20
20.0 %
15.0 %
10.0 %
5.0 %
0.0 %
High-flow nasal
cannula
Low-flow oxygen
support
Significant
decrease ▼
NNT = 7
Significant decrease in treatment failure in 72 hours (7.3% vs. 20%; RR 0.36, 95% CI 0.18 to 0.75)
Secondary outcomes
Significant decrease in intubation rate (7.3% vs. 16.7%; RR 0.44, 95% CI 0.21 to 0.92)
No significant difference in clinical stability (109 hours vs. 120.5 hours; AD -11.5 hours, 95% CI -103.42 to 80.42)
No significant difference in respiratory stability (107 hours vs. 108 hours; AD -1 hours, 95% CI -3.81 to 1.81)
Conclusion
In children, aged 2-59 months, with acute hypoxemic respiratory failure due to severe community-acquired pneumonia, high-flow nasal cannula was superior to low-flow oxygen support with respect to treatment failure in 72 hours.
Reference
Sasidaran Kandasamy, Ramachandran Rameshkumar, Thangavelu Sangaralingam et al. High-flow nasal oxygen in infants and children for early respiratory management of pneumonia-induced acute hypoxemic respiratory failure: the CENTURI randomized clinical trial. Intensive Care Med Paediatr Neonatal. 2024;2(1):15.
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