Randomised controlled trial of oxygen therapy and high-flow nasal therapy in African children with pneumonia

Document Type



Paediatrics and Child Health (East Africa)


Purpose: The life-saving role of oxygen therapy in African children with severe pneumonia is not yet established.

Methods: The 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-fow 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.

Results: The 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 per‑ missive 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.

Conclusions: Respiratory support with HFNT showing potential beneft should prompt further trials


This work was published before the author joined Aga Khan University.

Publication ( Name of Journal)

Springer Berlin Heidelberg

Creative Commons License

Creative Commons Attribution 4.0 International License
This work is licensed under a Creative Commons Attribution 4.0 International License.