High-Flow Oxygen Therapy vs. Continuous Positive Airway Pressure in Hospitalised Bronchiolitis: A Meta-Analysis

Area of Science:

• Pediatric critical care medicine
• Respiratory medicine
• Evidence-based medicine

Background:

• Bronchiolitis is a common viral respiratory infection in infants.
• High-flow oxygen therapy (HFOT) and continuous positive airway pressure (CPAP) are frequently used for respiratory support.
• Comparative data on their effectiveness and safety in pediatric intensive care units (PICUs) is essential.

Purpose of the Study:

• To compare the efficacy and safety of HFOT versus CPAP in infants under 24 months with bronchiolitis.
• To evaluate treatment failure rates, length of stay (LOS) in the PICU, and adverse events.

Main Methods:

• A systematic literature search was performed in PubMed and Scopus.
• A random-effects meta-analysis included data from prospective and retrospective studies.
• Outcomes analyzed included treatment failure (risk ratios) and PICU LOS (mean differences).

Main Results:

• The meta-analysis included nine studies.
• CPAP was associated with a significantly lower risk of treatment failure compared to HFOT (RR: 0.65; 95% CI: 0.51-0.81).
• No significant difference in PICU LOS was observed between the two interventions (MD: -0.10; 95% CI: -0.27 to 0.06). Adverse events were minor and more frequent with CPAP.

Conclusions:

• Both HFOT and CPAP are safe treatment options for bronchiolitis in infants.
• CPAP demonstrated a lower risk of treatment failure, suggesting it may be a more effective option.
• Findings are generalizable to pediatric patients requiring intensive care for bronchiolitis.