First ABC Study: FIRST-line support for assistance in breathing in children (FIRST-ABC) : a master protocol of two randomised trials to evaluate the non-inferiority of high flow nasal cannula (HFNC) versus continuous positive airway pressure (CPAP) for non-invasive respiratory support in paediatric critical care

To reduce the number of children needing invasive support, non-invasive breathing support methods like Continuous Positive Airway Pressure (CPAP) are used. CPAP provides oxygen or air through a face mask or into the nose. Although CPAP is beneficial, some children find it uncomfortable and some have complications. A more recent alternative is called High Flow Nasal Cannula (HFNC). HFNC provides oxygen or air through tiny tubes inserted into the nostrils. There is little research on whether HFNC is beneficial or safe. However, many paediatric critical care units are starting to use HFNC instead of CPAP as it is easier to use, and some children appear more comfortable on it, however we do not know which is either, is superior in children. We are also exploring this in both step up (to prevent intubation) and step down (following extubation) arms. The research involved two randomised trials in 19 critical care and HDUs across the UK. To determine whether CPAP or HFNC is better either used for ‘step up’ or for ‘step down’ use of this therapy.

This research will have considerable impact for both children, families and the healthcare service if one of the therapies is shown to be superior.

Funder: £1, 499 215. 19 NIHR HTA

Team: Dr Ramnaran P Chief Investigator, Dr Mark Peters, Dr Peter Davis, Dr Lyvonne Tume (co-investigator), Dr Roger Parslow, Dr Zia Hadique, Mrs Julie Letser, Mrs Deborah Onbashi, Prof Richard grieve, prof Kathy Rowan,  Paul Mouncey, Prof David Harrison and ICNRACT CTU