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High flow nasal cannula as respiratory support in treating infant bronchiolitis: a systematic review

Lien Moreel1, Marijke Proesmans2

  • 1Department of Internal Medicine, University Hospitals Leuven, Leuven, Belgium.

European Journal of Pediatrics
|April 2, 2020
PubMed

Insights

High flow nasal cannula (HFNC) is a safe respiratory support for infants with bronchiolitis, used when standard oxygen therapy is insufficient. It serves as a bridge to more invasive support but doesn't shorten hospital stays.

Area of Science:

  • Pediatrics
  • Respiratory Medicine
  • Critical Care

Background:

  • Bronchiolitis is a frequent childhood respiratory illness causing hospitalizations.
  • Standard treatment involves low-flow oxygen, with nCPAP or ventilation for severe cases.
  • High flow nasal cannula (HFNC) is an emerging respiratory support method.

Purpose of the Study:

  • To critically review prospective randomized controlled trials (RCTs) comparing HFNC with standard oxygen therapy (SOT) or nCPAP.
  • To provide guidance on the clinical positioning of HFNC for infant bronchiolitis.
  • To evaluate the efficacy and safety of HFNC in pediatric respiratory support.

Main Methods:

  • Systematic review and critical summary of data from prospective RCTs.
  • Comparison of HFNC against standard oxygen therapy (SOT) and nasal continuous positive airway pressure (nCPAP).
  • Focus on studies involving infants with bronchiolitis and hypoxemia.

Main Results:

  • HFNC is a safe respiratory support modality.
  • HFNC can be utilized as rescue therapy between SOT and nCPAP for inadequately supported patients.
  • HFNC did not demonstrate a reduction in the duration of oxygen requirement or hospital admission.

Conclusions:

  • HFNC is a safe option for respiratory support in infants with bronchiolitis.
  • HFNC serves as an intermediate therapy, bridging the gap between SOT and nCPAP.
  • Current evidence suggests HFNC does not shorten oxygen use or hospital stay duration.

Keywords:
BronchiolitisHigh flow nasal cannulaLength of hospital stayTherapy failure

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