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Published on: September 24, 2020
Application of the 2023 Italian guidelines for respiratory support management in acute viral bronchiolitis: a
Domenico Paolo La Regina1,2, Brigitte Fauroux2,3, Rocco Di Gioia1
1Maternal Child and Urological Sciences, Sapienza University of Rome, Rome, Rome, Italy.
Objective:
To evaluate the impact of the 2023 Italian guidelines on respiratory support management for acute viral bronchiolitis by comparing the use of low-flow oxygen (LFO) and high-flow nasal cannula (HFNC) therapies during the 2022-2023 and 2023-2024 epidemic seasons.
Design:
A retrospective, single-centre observational study.
Setting:
The paediatric emergency department of Policlinico Umberto I, Rome, Italy.
Patients:
A total of 202 infants (<12 months) with hypoxaemia due to acute viral bronchiolitis were hospitalised during the study periods. Eight patients were excluded due to chronic conditions or missing data.
Interventions:
The study compared LFO as a first-line therapy and HFNC as a second-line option in cases of LFO failure, before (2022-2023) and after (2023-2024) the guideline update.
Main Outcome Measures:
Rates of LFO and HFNC use, treatment failure, intubation, intensive care unit (ICU) admission, length of hospitalisation and oxygen therapy duration.
Results:
HFNC use as a first-line therapy decreased from 43.5% to 5.5%, while LFO use increased from 56.5% to 94.5%. LFO failure rates dropped significantly from 50% to 23%. No significant changes were observed in HFNC failure rates (12.5% vs 16.7%), ICU admissions or intubation rates. The average hospital stay decreased from 5.1±2.3 to 4.1±2.0 days, with a concomitant reduction in oxygen therapy duration.
Conclusions:
The 2023 Italian guidelines significantly reduced inappropriate HFNC use and hospital stay length without compromising patient outcomes. These findings support the step-up approach, emphasising LFO as the preferred first-line therapy.
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