World-first study signals change for child respiratory treatments

18 January 2023

Childhood respiratory treatments will change following a breakthrough study involving University of Queensland researchers that improves care standards and reduces healthcare costs.

PARIS-2 is the world’s first large-scale clinical trial in children aged one to five years who present at a hospital emergency department with a respiratory illness that requires oxygen.

The study compared standard oxygen therapy with nasal high-flow therapy, which increases oxygen levels via nasal cannula, in 1500 children at 14 hospitals across Australia and New Zealand.

The UQ Child Health Research Centre’s Dr Donna Franklin said this study clearly identifies which children are best treated with standard oxygen and how to use nasal high-flow oxygen therapy.

“The findings also show that a combination of the two oxygen methods can be safely used in rural and remote hospitals where child intensive care services may not exist,” Dr Franklin said.

“Until now, doctors have assumed that high-flow therapy works in all young children because previous evidence has shown that it is effective in babies less than 12 months old.

“However, PARIS-2 demonstrates that is not the case.

“We now know that it’s better to use a step-by-step process that starts children on standard oxygen and escalates to nasal high-flow therapy as needed.”

Up to 25 thousand Australian children present to hospital emergency departments with respiratory illnesses such as bronchiolitis, asthma and pneumonia each year, and three thousand are admitted to intensive care units (ICU) for respiratory failure, according to PARIS-2 Chief Investigator Dr Andreas Schibler from The Wesley Research Institute.

Dr Franklin said the findings of the PARIS 2 study will inform clinicians globally that not every child under the age of five will need high-flow oxygen therapy from the outset, depending on their illness severity.

“PARIS-2 shows the right way to use high-flow oxygen therapy in children. 

“Using a treatment escalation method will reduce ICU admissions for children and invasive ventilation.

“It will also lower the number of children being transferred from rural and remote areas to city hospitals.”

PARIS-2 builds on the success of the PARIS-1 study completed in 2016 and is part of the Paediatric Acute Respiratory Intervention Studies (PARIS), led by Dr Andreas Schibler from Queensland’s Wesley Research Institute.

It is published in the Journal of the American Medical Association (JAMA).
DOI: 10.1001/jama.2022.21805

The study was recently presented at the Society of Critical Care Medicine in San Fransico and was chosen as one of the top four journal articles in the past 12 months which will inform and change clinical practice.

Dr Franklin will now use the PARIS-2 findings to lead the PARIS on Country study in 18 rural and remote hospitals across the Torres and Cape, Townsville, North-West, and Cairns and Hinterland Hospital and Health Services. It aims to improve respiratory treatments and reduce child medical transfers to city hospitals.