High-flow nasal cannula therapy for children with bronchiolitis: a systematic review and meta-analysis

Lin, Jilei; Zhang, Yin; Xiong, Limei; Li, Sha; Gong, Caihui; Dai, Jihong

doi:10.1136/archdischild-2018-315846

Cited by 119 publications

(100 citation statements)

References 32 publications

(81 reference statements)

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“…29 In that small study, HFNC appears to have been better tolerated than CPAP (lower incidence of nasal injury), and the rate of intubation was similar (1 patient in each group). 29 A recent systematic review and meta-analysis 33 pooling data from four studies on HFNC and CPAP in 264 children with bronchiolitis also found no significant difference in the incidence of intubation between the two experimental groups.…”

Section: Discussionmentioning

confidence: 99%

High-Flow Nasal Cannula versus Continuous Positive Airway Pressure in Critical Bronchiolitis: A Randomized Controlled Pilot

Cesar

Bispo

Felix

et al. 2020

J Pediatr Intensive Care

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We conducted a randomized controlled pilot study in infants with critical bronchiolitis (n = 63) comparing high-flow nasal cannula (HFNC, n = 35) to continuous positive airway pressure (CPAP, n = 28). The primary outcome was treatment failure, defined as the need for bilevel positive pressure ventilation or endotracheal intubation. Treatment failure occurred in 10 patients (35.7%) in the CPAP group and 13 patients (37.1%) in the HFNC group (p = 0.88). Pediatric intensive care unit length of stay was similar between the CPAP and HFNC groups (5 [4–7] days and 5 [4–8] days, p = 0.46, respectively). In this pilot study, treatment with HFNC resulted in a rate of treatment failure similar to CPAP.

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Section: Discussionmentioning

confidence: 99%

High-Flow Nasal Cannula versus Continuous Positive Airway Pressure in Critical Bronchiolitis: A Randomized Controlled Pilot

Cesar

Bispo

Felix

et al. 2020

J Pediatr Intensive Care

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“…These 2 remarkable RCTs concluded that HFNC plays a role in rescue therapy for patients with moderate to severe bronchiolitis and stated that physicians should remember that the first use of HFNC does not modify the disease process. In a recent systematic review of 9 RCTs, 19) there were no differences in length of stay, duration of oxygen therapy, ICU transfer, intubation rate, respiratory rate (RR), SpO2, or adverse events in the HFNC versus standard oxygen therapy and nasal CPAP groups. The incidence of treatment failure in the HFNC group was lower than that of the standard oxygen group but higher than that of the nasal CPAP group.…”

Section: Acute Bronchiolitismentioning

confidence: 97%

High-flow nasal cannula oxygen therapy in children: a clinical review

Kwon

2020

Clin Exp Pediatr

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High-flow nasal cannula (HFNC) is a relatively safe and effective noninvasive ventilation method that was recently accepted as a treatment option for acute respiratory support before endotracheal intubation or invasive ventilation. The action mecha nism of HFNC includes a decrease in nasopharyngeal resistance, washout of dead space, reduction in inflow of ambient air, and an increase in airway pressure. In preterm infants, HFNC can be used to prevent reintubation and initial noninvasive respiratory support after birth. In children, flow level adjustments are crucial considering their maximal efficacy and complications. Randomized controlled studies suggest that HFNC can be used in cases of moderate to severe bronchiolitis upon initial low-flow oxygen failure. HFNC can also reduce intubation and mechanical ventilation in children with respiratory failure. Several observational studies have shown that HFNC can be beneficial in acute asthma and other respiratory distress. Multicenter randomized studies are warranted to determine the feasibility and adherence of HFNC and continuous positive airway pressure in pediatric intensive care units. The development of clinical guidelines for HFNC, including flow settings, indications, and contraindications, device management, efficacy identification, and safety issues are needed, particularly in children.

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“…A recent meta-analysis by Lin et al concluded for safety of HHHFNC in the treatment of bronchiolitis, underlining the lack of evidence regarding its efficacy compared with CPAP or supplementary oxygen. 8 However, available evidence is not focused on the neonatal population, so any speculation must take this aspect in mind.…”

Section: Heated Humidified High-flow Nasal Cannulamentioning

confidence: 99%

Respiratory Support of Neonate Affected by Bronchiolitis in Neonatal Intensive Care Unit

Bresesti

Lista

2020

Am J Perinatol

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Acute respiratory infections are very common medical emergency in early infancy, often requiring hospitalization. The most frequent respiratory infection at this stage of life is bronchiolitis, with a benign course in the majority of cases. However, especially during neonatal period, infants are at higher risk for developing complications, and ventilatory support of various degrees is needed. The two most widespread methods to provide noninvasive respiratory support are heated humidified high-flow nasal cannula and nasal continuous positive airway pressure. They are both used in neonatal intensive care unit to treat respiratory distress syndrome of the premature infants, and the main concept of recruiting and distending alveoli is valid also for respiratory failure occurring during bronchiolitis. However, there is still ongoing debate about the superiority of one method, and their real efficacy still need to be confirmed. Once respiratory failure does not respond to noninvasive ventilation, more intensive care must be provided in the form of conventional mechanical ventilation or high-frequency ventilation. There is currently no evidence of the optimal ventilation strategy to use, and a deeper comprehension of the pulmonary mechanics during bronchiolitis would be desirable to tailor ventilation according to the degree of severity. Further research is then urgently needed to better clarify these aspects. Key Points

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High-flow nasal cannula therapy for children with bronchiolitis: a systematic review and meta-analysis

Cited by 119 publications

References 32 publications

High-Flow Nasal Cannula versus Continuous Positive Airway Pressure in Critical Bronchiolitis: A Randomized Controlled Pilot

High-Flow Nasal Cannula versus Continuous Positive Airway Pressure in Critical Bronchiolitis: A Randomized Controlled Pilot

High-flow nasal cannula oxygen therapy in children: a clinical review

Respiratory Support of Neonate Affected by Bronchiolitis in Neonatal Intensive Care Unit

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