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High-flow nasal cannula lowered treatment failure versus low-flow oxygen, with no significant ventilation difference

European Respiratory Review (PubMed)Jul 1, 2026

AI-summarized from the linked source. Educational brief, not medical advice.

Brief summary

Across 18 randomized studies with 4,094 children aged 24 months or younger with bronchiolitis, high-flow nasal cannula reduced treatment failure versus low-flow oxygen but did not significantly reduce mechanical ventilation or outperform CPAP.

What NurseJet pulled from the source

This systematic review and meta-analysis included 18 randomized studies and 4,094 children aged 24 months or younger with bronchiolitis. Trials compared high-flow nasal cannula with low-flow nasal cannula or continuous positive airway pressure. High-flow therapy did not significantly reduce mechanical ventilation versus low-flow oxygen (RR 0.69, 95% CI 0.33 to 1.44) or CPAP (RR 0.90, 95% CI 0.65 to 1.24). Compared with low-flow oxygen, it reduced treatment failure (RR 0.44, 95% CI 0.23 to 0.87) and shortened pediatric ICU stay by 0.40 days (95% CI 0.02 to 0.78 days shorter). Compared with CPAP, treatment failure and PICU stay did not differ significantly. The review supports high-flow therapy as an escalation option from low-flow oxygen, but it does not show that high-flow prevents intubation or performs better than CPAP across the studied outcomes.

Why this matters for nurses

Pediatric nurses frequently monitor infants receiving escalating oxygen support and identify signs of treatment failure. This review matters because it separates a lower failure rate versus low-flow oxygen from the absence of evidence that high-flow reduces mechanical ventilation or outperforms CPAP.

Bedside takeaway

Worth knowing that high-flow nasal cannula reduced treatment failure versus low-flow oxygen in bronchiolitis, but did not significantly reduce mechanical ventilation or outperform CPAP.

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Key takeaways

Eighteen randomized studies included 4,094 children aged 24 months or younger with bronchiolitis.
High-flow nasal cannula reduced treatment failure versus low-flow oxygen, with a pooled risk ratio of 0.44.
High-flow therapy did not significantly reduce mechanical ventilation compared with either low-flow oxygen or CPAP.
Treatment failure and PICU length of stay did not differ significantly between high-flow therapy and CPAP.

Practice implications

For pediatric teams, the findings support following locally approved criteria for starting, monitoring, and escalating high-flow therapy rather than assuming it prevents intubation. Device selection, settings, reassessment, and movement to CPAP or invasive support remain clinician-directed and protocol-specific.

Limitations & cautions

The review pooled studies with different respiratory-support comparisons, and the abstract does not provide certainty ratings, detailed risk-of-bias findings, or standardized definitions of treatment failure. It also does not identify which patient subgroups or high-flow protocols are most likely to benefit.
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Citations

Exact source links

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European Respiratory Review (PubMed)

European Respiratory Review (PubMed). Respiratory support in paediatric patients with bronchiolitis: a systematic review and meta-analysis.

Open original source

https://pubmed.ncbi.nlm.nih.gov/42386310/

Professional education only

This summary does not replace clinical judgment, facility policy, provider orders, or official guidelines. Verify practice changes against the original source and local protocol.

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American Journal of Respiratory and Critical Care Medicine (PubMed)Jul 13, 2026Research Article

In a 115-patient multicenter randomized trial of acute respiratory failure, early in-bed cycling plus intravenous amino acids appeared safe but did not improve discharge walking distance, other functional outcomes, or 6-month outcomes versus usual care.

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Research ArticleResearchWorkflowAI summary · original source linked below

Investigators at multiple centers randomized 115 adults with acute respiratory failure, more than 90% of whom were mechanically ventilated, to usual care alone or usual care plus 45 minutes per day of in-bed cycling and intravenous amino acids targeting total protein intake of 2.0 to 2.5 g/kg/day. The intervention delivered 40 plus or minus 7 minutes of cycling per day and 1.9 plus or minus 0.6 g/kg/day of protein, versus 0.9 plus or minus 0.6 g/kg/day with usual care. At hospital discharge, median 6-minute walk distance was 108 m in the intervention group and 95 m with usual care; the median difference was 10 m (95% CI -75 to 84; P=.51). Other ICU-discharge, hospital-discharge, and 6-month outcomes were also similar. Enrollment stopped early because recruitment was slow, not because of safety concerns. The combined strategy appeared safe but did not improve the trial's functional outcomes.

Key takeaways

The multicenter phase 2 trial randomized 115 adults with acute respiratory failure, and more than 90% were mechanically ventilated.
The intervention combined daily in-bed cycling with intravenous amino acids and approximately doubled achieved total protein intake.
Discharge 6-minute walk distance did not differ significantly between intervention and usual-care groups.
Secondary outcomes through 6 months were also similar, and enrollment stopped early because recruitment was slow.

Why this matters on shift

Early mobility and nutrition require coordinated bedside work and are intended to address long-lasting weakness after critical illness. This trial matters for ICU nurses because it tested an intensive combined protocol with blinded functional assessment and found no added functional benefit over usual care.

Bedside takeaway

Be aware that adding early in-bed cycling and IV amino acids to usual ICU care did not improve discharge walking distance or 6-month outcomes in this 115-patient trial, although the combined protocol appeared safe.

Nursing implications

For ICU teams, the result supports reviewing goals, workload, tolerance, and local evidence before adding this exact combined protocol. It should not be read as a reason to stop ordered mobility or nutrition practices, because cycling and amino acids were tested together rather than separately.

Limitations & cautions

The phase 2 trial randomized 115 patients and stopped before its planned 128 evaluable participants because of slow recruitment. The combined design cannot isolate cycling from amino acids, the confidence interval around walking distance was wide, and findings may not apply beyond adults with acute respiratory failure.
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Citations · exact source links

American Journal of Respiratory and Critical Care Medicine (PubMed). Nutrition and Exercise in Critical Illness (NEXIS) trial: randomized trial of combined in-bed cycling and intravenous amino acid plus usual care.

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The Journal of Maternal-Fetal & Neonatal Medicine (PubMed)Jul 8, 2026Research Article

In a secondary analysis of 1,783 nulliparous participants from the 19-center PRIME randomized trial, a biomarker screen-guided, multicomponent care pathway reduced NICU admissions from 16.4% with routine care to 12.8%.

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Research ArticleResearchAI summary · original source linked below

The PRIME trial randomized 5,018 otherwise low-risk singleton pregnancies to routine care or a screen-guided strategy using the IGFBP4/SHBG biomarker ratio. This secondary analysis focused on 1,783 nulliparous participants, whose lack of prior obstetric history can make preterm-birth risk harder to identify. Participants in the screen-guided arm who screened as higher risk were offered vaginal progesterone, low-dose aspirin, and weekly telephone nursing support. Composite neonatal morbidity was lower with screen-guided care, and NICU admission occurred in 12.8% of the screen-guided group versus 16.4% with routine care (P=0.039), an adjusted OR of 0.75 (95% CI 0.57 to 0.98). The authors calculated that 28 nulliparous pregnancies would need screening to prevent one NICU admission; reductions were concentrated in spontaneous preterm births. No serious adverse events were reported in the screen-guided subgroup. Because this was a subgroup analysis of a multicomponent pathway, the effect cannot be assigned to screening, medication, or nursing follow-up alone.

Key takeaways

The secondary analysis included 1,783 nulliparous participants from a 5,018-participant, 19-center randomized trial.
Higher-risk participants in the screen-guided arm were offered progesterone, low-dose aspirin, and weekly telephone nursing support.
NICU admission was 12.8% with screen-guided care versus 16.4% with routine care (adjusted OR 0.75, 95% CI 0.57 to 0.98).
The multicomponent pathway and subgroup design prevent attributing the result to any single component.

Why this matters on shift

First-time pregnancies lack a prior obstetric history to help identify preterm-birth risk, while obstetric nurses coordinate monitoring, education, and follow-up across pregnancy. This study matters because it tests a risk-guided pathway in that specific population and reports a neonatal outcome rather than screening performance alone.

Bedside takeaway

Worth knowing that a multicomponent, biomarker screen-guided pathway reduced NICU admission from 16.4% to 12.8% in a nulliparous PRIME subgroup, but the effect cannot be assigned to any one component.

Nursing implications

For labor-and-delivery and prenatal teams, the findings support awareness of locally approved risk-screening pathways and reliable follow-up when a patient screens higher risk. They do not justify adopting this biomarker or changing aspirin or progesterone use outside institutional protocols and prescriber-directed care.

Limitations & cautions

This was a secondary subgroup analysis rather than the trial's full primary analysis. The screen-guided arm combined a biomarker test, progesterone, aspirin, and nursing calls, so the contribution of each component is unknown; findings apply to otherwise low-risk singleton nulliparous pregnancies and may not extend to other populations.
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Citations · exact source links

The Journal of Maternal-Fetal & Neonatal Medicine (PubMed). Biomarker screen-guided care for preterm birth risk in nulliparous pregnancies: a subgroup analysis of the PRIME randomized controlled trial.

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PLOS One (PubMed)Jul 10, 2026Research Article

In a retrospective cohort of 102 mechanically ventilated ICU patients, a documented nurse-led targeted sedation-analgesia workflow was associated with shorter ventilation (median 4.3 vs 5.9 days), more RASS assessments within target (74.0% vs 61.5%), and less deep-sedation exposure.

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Research ArticleResearchWorkflowQuality ImprovementAI summary · original source linked below

This single-center retrospective observational cohort examined adults who received invasive mechanical ventilation for at least 24 hours during 2024 and 2025. Patients were classified as receiving usual physician-directed care (48 patients) or a nurse-led targeted sedation-analgesia workflow (54 patients) using documentation of daily RASS targets, assessment frequency, nurse-driven titration, and closed-loop reassessment. Median ventilation duration was 4.3 days in the nurse-led group versus 5.9 days with usual care (P less than 0.01), and the mean proportion of RASS assessments within target was 74.0% versus 61.5% (P less than 0.01). Deep-sedation exposure was 16.1% versus 27.6% (P less than 0.01), agitation exposure was 9.1% versus 12.4% (P=0.03), and ICU stay averaged 8.0 versus 9.7 days (P=0.02). After adjustment, the nurse-led workflow remained associated with shorter ventilation (adjusted ratio 0.79, 95% CI 0.67 to 0.93), while delirium was not significantly different and no differences were detected in unplanned extubation, 48-hour reintubation, tracheostomy, or 28-day mortality. The authors stress that the study shows association, not causal effectiveness.

Key takeaways

The study compared 54 patients managed with a documented nurse-led targeted workflow and 48 who received usual physician-directed sedation care.
Median invasive ventilation was shorter with the nurse-led workflow (4.3 vs 5.9 days), and 74.0% of RASS assessments were within target versus 61.5% with usual care.
Deep-sedation exposure was lower (16.1% vs 27.6%), as were agitation exposure (9.1% vs 12.4%) and mean ICU length of stay (8.0 vs 9.7 days).
Delirium and measured safety outcomes were not significantly different, and retrospective classification prevents a causal conclusion.

Why this matters on shift

Sedation targets can drift when assessment, titration, and reassessment are not linked into a reliable loop, prolonging exposure to deep sedation. This study matters for ICU nurses because it examines a workflow built around nursing assessment and protocol-guided response, with clinically relevant differences in target attainment and ventilator duration.

Bedside takeaway

Be aware that in a 102-patient retrospective ICU cohort, a nurse-led targeted sedation workflow was linked to 4.3 versus 5.9 ventilator days and more RASS assessments on target, but causality remains unproven.

Nursing implications

For ICU nurses, the findings reinforce consistent documentation of the daily RASS goal, scheduled assessment, protocol-aligned titration, and reassessment after changes when those steps are authorized by local policy and orders. They do not establish that a nurse-led workflow alone shortens ventilation, so broader sedation, analgesia, awakening, and liberation practices still need to be considered.

Limitations & cautions

This was a single-center retrospective study of 102 patients, with groups defined from documentation rather than random assignment, creating risk of selection bias, residual confounding, and misclassification. Adjustment was limited, the study was too small for uncommon safety events, and it found no significant difference in delirium, reintubation, unplanned extubation, tracheostomy, or 28-day mortality.
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Citations · exact source links

PLOS One (PubMed). Association of nurse-led targeted sedation-analgesia management with ventilation duration and sedation quality in mechanically ventilated patients.

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Open original sourceFull brief

AI-summarized from the linked source. Review the original article before applying to practice.

Key takeaways

Practice implications

Limitations & cautions

Exact source links

More updates for this clinical area

Early in-bed cycling plus IV amino acids did not improve functional outcomes in the NEXIS ICU trial

Screen-guided care reduced NICU admissions from 16.4% to 12.8% in a nulliparous PRIME trial subgroup

A nurse-led sedation workflow was linked to shorter ventilation and more RASS assessments on target in a 102-patient ICU cohort