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High-Flow Oxygen and Other Noninvasive Respiratory Support Therapies in Bronchiolitis: Systematic Review and Network
Miriam Gutiérrez Moreno1, Pablo Del Villar Guerra2, Alberto Medina3
1Department of Paediatrics, Complejo Asistencial de Zamora, Zamora, Spain.
Insights
High-flow nasal cannula (HFNC) shows no advantage over conventional low-flow oxygen therapy (LFOT) or noninvasive ventilation (NIV) in treating bronchiolitis. Evidence does not support HFNC as superior for initial or rescue treatment in young children.
Area of Science:
- Pediatrics
- Respiratory Medicine
- Critical Care
Background:
- Bronchiolitis is a common respiratory infection in infants.
- Noninvasive respiratory support is frequently used in managing bronchiolitis.
- High-flow nasal cannula (HFNC) is increasingly utilized, necessitating evidence-based evaluation.
Purpose of the Study:
- To systematically review the effectiveness of noninvasive respiratory support techniques in pediatric bronchiolitis.
- To compare high-flow nasal cannula (HFNC) with conventional low-flow oxygen therapy (LFOT) and noninvasive ventilation (NIV).
Main Methods:
- Systematic review including pairwise and network meta-analyses of randomized controlled trials (RCTs) and non-RCT studies.
- Inclusion of patients under 24 months with bronchiolitis requiring noninvasive support.
- Analysis of outcomes such as invasive mechanical ventilation, oxygen days, and treatment failure.
Main Results:
- HFNC was associated with lower risk of invasive mechanical ventilation than NIV in nonexperimental studies, but not in RCTs.
- HFNC proved more effective than LFOT in reducing oxygen days and treatment failure.
- Network meta-analysis indicated NIV was most effective in avoiding invasive mechanical ventilation and reducing oxygen therapy days.
Conclusions:
- Experimental evidence does not support HFNC as having advantages over LFOT for initial treatment.
- Evidence does not support HFNC as having advantages over NIV for rescue treatment.
- Methodological heterogeneity was noted in included studies, particularly for oxygen therapy days and length of hospital stay.
Objectives:
We present a systematic review on the effectiveness of noninvasive respiratory support techniques in bronchiolitis.
Data Sources:
Systematic review with pairwise meta-analyses of all studies and network meta-analyses of the clinical trials.
Study Selection:
Patients below 24 months old with bronchiolitis who require noninvasive respiratory support were included in randomized controlled trials (RCTs), non-RCT, and cohort studies in which high-flow nasal cannula (HFNC) was compared with conventional low-flow oxygen therapy (LFOT) and/or noninvasive ventilation (NIV).
Data Extraction:
Emergency wards and hospitalized patients with bronchiolitis.
Data Synthesis:
A total of 3,367 patients were analyzed in 14 RCTs and 8,385 patients in 14 non-RCTs studies. Only in nonexperimental studies, HFNC is associated with a lower risk of invasive mechanical ventilation (MV) than NIV (odds ratio, 0.49; 95% CI, 0.42-0.58), with no differences in experimental studies. There were no differences between HFNC and NIV in other outcomes. HFNC is more effective than LFOT in reducing oxygen days and treatment failure. In the network meta-analyses of clinical trials, NIV was the most effective intervention to avoid invasive MV (surface under the cumulative ranking curve [SUCRA], 57.03%) and to reduce days under oxygen therapy (SUCRA, 79.42%), although crossover effect estimates between interventions showed no significant differences. The included studies show methodological heterogeneity, but it is only statistically significant for the reduction of days of oxygen therapy and length of hospital stay.
Conclusions:
Experimental evidence does not suggest that high-flow oxygen therapy has advantages over LFOT as initial treatment nor over NIV as a rescue treatment.
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