Imperial College London
Alternate

ProfessorKathMaitland

Faculty of Medicine, Department of Surgery & Cancer

Professor of Tropical Paediatric Infectious Disease
 
 
 
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Contact

 

k.maitland CV

 
 
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Location

 

Based full-time at KEMRI/Wellcome Programme, KenyaQueen Elizabeth and Queen Mary HospitalSt Mary's Campus

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Summary

 

Publications

Citation

BibTex format

@article{Maitland:2021:10.1007/s00134-021-06385-3,
author = {Maitland, K and Kiguli, S and Olupot-Olupot, P and Hamaluba, M and Thomas, K and Alaroker, F and Opoka, RO and Tagoola, A and Bandika, V and Mpoya, A and Mnjalla, H and Nabawanuka, E and Okiror, W and Nakuya, M and Aromut, D and Engoru, C and Oguda, E and Williams, TN and Fraser, JF and Harrison, D and Rowan, K and on, behalf of the COAST trial group},
doi = {10.1007/s00134-021-06385-3},
journal = {Intensive Care Medicine},
pages = {566--576},
title = {Randomised controlled trial of oxygen therapy and high flow nasal therapy in African children with pneumonia},
url = {http://dx.doi.org/10.1007/s00134-021-06385-3},
volume = {47},
year = {2021}
}
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RIS format (EndNote, RefMan)

TY  - JOUR
AB  - PurposeThe life-saving role of oxygen therapy in African children with severe pneumonia is not yet established.MethodsThe open-label fractional-factorial COAST trial randomised eligible Ugandan and Kenyan children aged > 28 days with severe pneumonia and severe hypoxaemia stratum (SpO2 < 80%) to high-flow nasal therapy (HFNT) or low-flow oxygen (LFO: standard care) and hypoxaemia stratum (SpO2 80–91%) to HFNT or LFO (liberal strategies) or permissive hypoxaemia (ratio 1:1:2). Children with cyanotic heart disease, chronic lung disease or > 3 h receipt of oxygen were excluded. The primary endpoint was 48 h mortality; secondary endpoints included mortality or neurocognitive sequelae at 28 days.ResultsThe trial was stopped early after enrolling 1852/4200 children, including 388 in the severe hypoxaemia stratum (median 7 months; median SpO2 75%) randomised to HFNT (n = 194) or LFO (n = 194) and 1454 in the hypoxaemia stratum (median 9 months; median SpO2 88%) randomised to HFNT (n = 363) vs LFO (n = 364) vs permissive hypoxaemia (n = 727). Per-protocol 15% of patients in the permissive hypoxaemia group received oxygen (when SpO2 < 80%). In the severe hypoxaemia stratum, 48-h mortality was 9.3% for HFNT vs. 13.4% for LFO groups. In the hypoxaemia stratum, 48-h mortality was 1.1% for HFNT vs. 2.5% LFO and 1.4% for permissive hypoxaemia. In the hypoxaemia stratum, adjusted odds ratio for 48-h mortality in liberal vs permissive comparison was 1.16 (0.49–2.74; p = 0.73); HFNT vs LFO comparison was 0.60 (0.33–1.06; p = 0.08). Strata-specific 28 day mortality rates were, respectively: 18.6, 23.4 and 3.3, 4.1, 3.9%. Neurocognitive sequelae were rare.ConclusionsRespiratory support with HFNT showing potential benefit should prompt further trials.
AU  - Maitland,K
AU  - Kiguli,S
AU  - Olupot-Olupot,P
AU  - Hamaluba,M
AU  - Thomas,K
AU  - Alaroker,F
AU  - Opoka,RO
AU  - Tagoola,A
AU  - Bandika,V
AU  - Mpoya,A
AU  - Mnjalla,H
AU  - Nabawanuka,E
AU  - Okiror,W
AU  - Nakuya,M
AU  - Aromut,D
AU  - Engoru,C
AU  - Oguda,E
AU  - Williams,TN
AU  - Fraser,JF
AU  - Harrison,D
AU  - Rowan,K
AU  - on,behalf of the COAST trial group
DO  - 10.1007/s00134-021-06385-3
EP  - 576
PY  - 2021///
SN  - 0342-4642
SP  - 566
TI  - Randomised controlled trial of oxygen therapy and high flow nasal therapy in African children with pneumonia
T2  - Intensive Care Medicine
UR  - http://dx.doi.org/10.1007/s00134-021-06385-3
UR  - http://hdl.handle.net/10044/1/88633
VL  - 47
ER  -
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