A COASTal view: where prior beliefs and uncertainty collide

Excerpt

The Children’s Oxygen Administration Strategies Trial (COAST) was an ambitious project based in Uganda and Kenya. The target population was children with severe pneumonia as assessed by presentation of peripheral oxygen saturation into two strata (hypoxaemia: SpO₂ 80–92% and severe hypoxaemia: SpO₂ < 80%). The comparisons were between high-flow humidified nasal therapy (HFNT) and standard low-flow nasal oxygen in the severe hypoxaemia stratum, but also in a fractional factorial design of more liberal oxygen use vs. permissive hypoxaemia in the less severe stratum. The primary outcome measure was mortality at 48 h. The trial was conducted by a team with an outstanding track record of delivering large pragmatic and practice-changing trials in low-income settings. We had the privilege of being independent members of the Trial Steering Committee (TSC). …