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Journal update monthly top five
  1. Osama Akrama1,
  2. Luke Armstrong1,
  3. Moudgalya Kumar Desai1,
  4. Alison Horner Le Riche2,
  5. Liza Keating1,
  6. Charlotte Knowles1,
  7. Yanithra Perera1,
  8. Thomas Porter1,
  9. Robert Hirst3
  1. 1 Emergency Department, Royal Berkshire NHS Foundation Trust, Reading, UK
  2. 2 Trust Education Center, Royal Berkshire NHS Foundation Trust, Reading, UK
  3. 3 Emergency Department, North Bristol NHS Trust, Bristol, UK
  1. Correspondence to Dr Osama Akrama, Emergency Department, Royal Berkshire NHS Foundation Trust, Reading, UK; dr.osamaakrama{at}

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This month’s update is by the University Department of Emergency Medicine in Reading. We used a multimodal search strategy, drawing on free open-access medical education resources and literature searches. We identified the five most interesting and relevant papers (decided by consensus) and have highlighted the main findings, key limitations and clinical bottom line for each paper.

The papers are ranked as:

  • Worth a peek—interesting, but not yet ready for prime time.

  • Head turner—new concepts.

  • Game changer—this paper could/should change practice.

High-flow oxygen therapy in moderate to severe bronchiolitis: a randomised controlled trial by Kooiman et al

Topic: paediatrics

Outcome rating: worth a peek

Bronchiolitis is a common childhood illness whose treatment is primarily supportive. The use of high-flow (HF) oxygen in this patient group is widespread although the evidential benefit of this intervention is uncertain.1

This multicentre randomised controlled trial included 107 children <2 years of age with moderate to severe bronchiolitis. They were randomised to HF or low flow (LF) with no crossover. HF was given at 2 L/kg for the first 10 kg and 0.5 L/kg for every kg thereafter; LF was given at a maximum of 3 L/min. The primary outcome was improved vital signs and work of breathing within 24 hours. Secondary outcomes included length of hospital stay, duration of oxygen support, escalation of care to paediatric intensive care unit (PICU) or use of nasogastric feeding.

No statistically or clinically significant difference was noted between two groups for the primary or secondary outcomes. Limitations included a sample size which did not meet its power calculation, and therefore, this study might be underpowered. Additionally, the primary outcome was a non-patient-centred composite outcome. Lower flow rates of HF oxygen were used compared with previous studies and conventional clinical practice.

Bottom line

This trial advances the ongoing debate around the value of HF for patients with bronchiolitis, questioning the additional benefit of providing HF oxygen to this patient group.

Multiple electrolytes solution versus saline as bolus fluid for resuscitation in paediatric septic shock: a multicentre randomised clinical trial by Sankar et al

Topic: fluid resuscitation

Outcome rating: head turner

While there …

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  • Twitter @DrYaniPerera, @hirstposition

  • Contributors OA, LA, MKD, AHLR, LK, CK, YP and TP were involved in the search and creation of the initial manuscript. RH was involved with supervision, creation and revision of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

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