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Impact of different nebulisation systems on patient comfort in bronchiolitis: a randomised controlled cross-over trial
  1. Juan Valencia-Ramos1,2,
  2. Carlos Ochoa Sangrador3,
  3. María García1,
  4. Pablo Oyagüez1,
  5. Juan Arnaez4,5
  1. 1 Paediatric Intensive Care Unit, Complejo Asistencial Universitario de Burgos, Burgos, Spain
  2. 2 Ciencias de la Salud, University of Burgos, Burgos, Spain
  3. 3 Pediatrics, Hospital Virgen de la Concha, Zamora, Spain
  4. 4 Neonatology, Complejo Asistencial Universitario de Burgos, Burgos, Spain
  5. 5 Fundación NeNe, Burgos, Spain
  1. Correspondence to Dr Juan Valencia-Ramos, Paediatric Intensive Care Unit, Complejo Asistencial Universitario de Burgos, Burgos 09006, Spain; jvalenra{at}


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.

  • intensive care units
  • respiratory medicine
  • technology
  • virology
  • child welfare

Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

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Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

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  • Contributors JVR: guarantor, study idea and design, data mining, data analysis and interpretation, manuscript draft and final approval. COS, MG, PO: data mining, critical review of the intellectual content and final approval of the manuscript version presented here. JA: study idea, data mining, data analysis and interpretation.

  • Funding This study was supported by Fundación Ernesto Sánchez Villares (FESV) (01/2017), and Aerogen (Philips) provided nebulisers free of charge. The opinions, results and conclusions reported in this paper are those of the authors and are independent of funding sources. No endorsement by FESV is intended or inferred.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.