Respiratory Support in Bronchiolitis: A Narrative Review of the Evidence for and Against High-Flow Nasal Cannula...

Area of Science:

• Pediatric Respiratory Medicine
• Critical Care
• Evidence-Based Medicine

Background:

• Bronchiolitis is a major cause of pediatric hospitalization.
• High-flow nasal cannula (HFNC) use has risen significantly for respiratory support in children.
• Clinical benefits of HFNC for bronchiolitis remain uncertain despite increased utilization.

Purpose of the Study:

• To review and evaluate the evidence for and against HFNC use in infants and young children with bronchiolitis.
• To assess the impact of HFNC on clinical outcomes and healthcare resource utilization.

Main Methods:

• Narrative review of existing literature.
• Analysis of observational studies and recent randomized controlled trials (RCTs).
• Comparison of HFNC outcomes against conventional low-flow oxygen therapy.

Main Results:

• Recent RCTs show no consistent benefit of HFNC over low-flow oxygen regarding length of stay, oxygen duration, PICU transfers, or mechanical ventilation.
• HFNC may reduce treatment failure in non-responders to low-flow therapy.
• Increased HFNC use is linked to higher costs, more PICU admissions, and potential complications (aerophagia, feeding delays, air leaks).

Conclusions:

• Evidence for HFNC in non-hypoxic respiratory distress is limited; guidelines do not support 'oxygen for comfort'.
• A stepwise, evidence-guided approach using objective scoring systems is recommended to optimize bronchiolitis management and prevent overuse.
• Further research is needed to define clear indications, standardized criteria, and the role of HFNC in non-hypoxic bronchiolitis.