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

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 (SpO 2 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 SpO 2 75%) randomised to HFNT ( n = 194) or LFO ( n = 194) and 1454 in the hypoxaemia stratum (median 9 months; median SpO 2 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 SpO 2