Children aged 1–4 years plus 364 days presenting with AHRF and require hospital admission despite initial assessment and therapy and an ongoing oxygen requirement (SpO2 <90/92%* in room air, dependent on hospital policy) and have a persistent tachypnoea of ≥35 breath/min for ≥10 mins at the time of randomisation
| Oxygen requirement and therapy in the emergency department existed for longer than 4 hours prior to inclusion (excludes oxygen given in ambulance or other hospital) Previous use of high-flow during this illness episode Upper airway obstruction Craniofacial malformations Critically ill infants requiring immediate higher level of respiratory support that is, non-invasive or invasive ventilation, low level of consciousness OR Critically ill with immediate need for intubation or non-invasive ventilation with the need of closer observation in ICU Basal skull fracture Trauma Cyanotic heart disease (eg, blue baby, expected normal saturation in room air <90/92%) Home oxygen therapy Palliative care Cystic fibrosis Oncology Child protection patients
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