Impact of different nebulisation systems on patient comfort in bronchiolitis: a randomised controlled cross-over trial

Abstract

Objective: To test the hypothesis that greater comfort is achieved using a nebuliser integrated into a high-flow nasal cannula (nebulisation system integrated in high-flow nasal cannula (NHF)) than using a jet nebuliser (JN), and to explore differences in analgesia requirement and the possibility of feeding during nebulisation.

Design: Randomised cross-over trial.

Setting: Paediatric intensive care unit.

Patients: Children aged <24 months diagnosed with bronchiolitis between November 2016 and May 2017.

Interventions: Nebulisations using NHF and JN.

Main outcome measures: COMFORT–Behaviour Scale (CBS) and Numerical Rating Comfort Scale (NRSc) were used to measure comfort, and Numerical Rating Satisfaction Scale (NRSs) was used to assess satisfaction before, during and after nebulisation. Other variables included feeding, analgesia, need for being held and respiratory and heart rates.

Results: Thirty-three children with 233 nebulisations were included in the study. The median age was 3.0 (IQR 2–9) months. Comfort and satisfaction were greater with NHF than with JN. The median staff-recorded CBS, NRSc and NRSs scores for NHF versus JN were 13 (IQR 9–15) vs 17 (IQR 13–23), 8 (IQR 7–0) vs 7 (IQR 4–8), and 4 (IQR 3–4) vs 2 (IQR 2–3), respectively; and caregiver-recorded scores were 12 (IQR 10–15) vs 19 (IQR 13–24), 9 (IQR 7–10) vs 4 (IQR 1–6), and 4 (IQR 3–4) vs 2 (IQR 1–3), respectively (p<0.001). Children who received NHF had lower cardiac and respiratory rates, needed to be held less often during therapy and required less analgesia (p<0.001).

Conclusion: Nebulisation through NHF appears to be a better alternative to JN in terms of comfort and satisfaction as well as making feeding possible during nebulisation.