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Child Health Guideline Identifier

Respiratory - PARIS 2 trial

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The PARIS 2 trial has begun, investigating if early use of high flow therapy is superior to standard oxygen therapy in an RCT for children aged 1- 4yrs + 364 days presenting with AHRF with a reduced hospital length of stay.

Teaching resources and guides are on the CED research link (ADHB staff only)

Inclusion criteria

  • Age 1-4 years ( up until 5th birthday)
  • Presents with respiratory Illness
  • Is being ADMITTED to hospital
  • Has an O2 requirement SaO2 <92% in room air for up to 10 mins
  • Persistent tachapnoea RR> 35 resps/min for > 10 mins

Exclusion criteria

  • O2 requirement and therapy in the ED longer than 4 hours ( excludes ambulance or other hospital)
  • Previous use of high flow therapy during this illness episode
  • Upper airway obstruction
  • Apnoeas
  • Craniofacial malformation
  • Fractured basal skull
  • Trauma
  • Decreased LOC
  • Cyanotic Heart Disease
  • Home O2 therapy
  • Tracheostomy
  • Cystic Fibrosis
  • Oncology patient
  • Palliative care patient
  • Critically ill with immediate need for intubation or NIV and/or need for ICU admission
  • Child Protection case

All patients are consented into the study in CED. Patients will arrive to the ward either:

  • Having commenced treatment - either low-flow or high-flow oxygen or
  • Without an oxygen requirement but consented to the study if requires oxygen during their stay. Call the CED shift coordinator for randomisation if required.

PARIS 2 flowchart

  • Low flow therapy is weaned as usual until child maintains Sao2 >92 %. High flow on room air (21%) can be weaned after 2 hours if SpO2 are 92-98%
  • High flow with FiO2 is weaned as usual by reducing FiO2 in 5% steps or more frequent if tolerated
  • On high flow, wean the FiO2, do not wean the flow rate

The CED research nurses will visit the ward daily if we have patients on the study. More information can be found in the study box or on the CED internet page (ADHB staff only)

Please place all PARIS 2 notes in the study box after discharge for the CED research team to collect.

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Document Control

  • Date last published: 31 January 2019
  • Document type: Clinical Guideline
  • Services responsible: Children’s Emergency Department
  • Owner: Stuart Dalziel
  • Editor: Greg Williams
  • Review frequency: 2 years

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