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Update on the Role of High-Flow Nasal Cannula in Infants with Bronchiolitis

Valentina Fainardi1, Lara Abelli1, Maria Muscarà1

  • 1Pediatric Clinic, Pietro Barilla Children's Hospital, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy.

Children (Basel, Switzerland)
|January 27, 2021
PubMed

Insights

High-flow nasal cannula (HFNC) is increasingly used for bronchiolitis (BR) in infants. While safe for mild to moderate cases, clear guidelines are needed to define its role versus standard oxygen therapy and other noninvasive methods.

Area of Science:

  • Pediatrics
  • Respiratory Medicine
  • Infectious Diseases

Background:

  • Bronchiolitis (BR), primarily caused by RSV, is a common severe lower respiratory tract infection in infants.
  • Current treatments for BR include nutritional support and oxygen therapy, with standard oxygen therapy (SOT) for mild cases and invasive mechanical ventilation (IMV) for severe cases.
  • Noninvasive ventilation methods like BiPAP, CPAP, and HFNC have emerged to improve oxygen delivery and avoid IMV.

Purpose of the Study:

  • To review the role of high-flow nasal cannula (HFNC) in treating infants with bronchiolitis (BR).
  • To analyze the current literature on HFNC efficacy and its comparison with other oxygenation methods for BR.
  • To identify the need for consistent guidelines regarding HFNC initiation and discontinuation in pediatric BR management.

Main Methods:

  • This study is a narrative review of existing literature on HFNC use in infant bronchiolitis.
  • The review analyzes clinical studies and reports on the effectiveness, tolerability, and safety of HFNC.
  • Literature was examined to assess HFNC's role in preventing respiratory failure and its comparative benefits against SOT, CPAP, and BiPAP.

Main Results:

  • High-flow nasal cannula (HFNC) is widely adopted for its simplicity, safety, and good tolerability in treating BR.
  • Despite widespread use, the precise role of HFNC in preventing respiratory failure in pediatric BR is not clearly defined.
  • Evidence is insufficient to establish if HFNC offers superior benefits over standard oxygen therapy (SOT) or when it can replace CPAP or BiPAP.

Conclusions:

  • High-flow nasal cannula (HFNC) is a safe and effective option for mild to moderate bronchiolitis (BR) unresponsive to standard oxygen therapy (SOT).
  • There is a significant need for multicenter studies and official clinical guidelines to standardize HFNC use in pediatric BR.
  • Further research is required to precisely define HFNC's benefits compared to SOT and its optimal role relative to CPAP and BiPAP in BR management.

Keywords:
BiPAPCPAPHFNCbronchiolitisoxygen therapy

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