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

Cesar, Regina Grigolli; Bispo, Bibiane; Felix, Priscilla Helena Costa Alves; Modolo, Maria carolina; Souza, Andreia Aparecida Freitas; Horigoshi, Nelson; Rotta, Alexandre T.

doi:10.1055/s-0040-1709656

Cited by 29 publications

(44 citation statements)

References 31 publications

(54 reference statements)

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“…The search strategy identified 2943 titles and abstracts after duplicates were deleted; 308 full articles were screened, and 23 met the inclusion criteria. 16–19 21–39 8 were excluded from the meta-analyses as they had insufficient data 28–32 34–36 and 15 were included in the meta-analyses ( figure 1 ). 16–19 21–27 33 37–39 …”

Section: Resultsmentioning

confidence: 99%

“… 16–19 21–39 8 were excluded from the meta-analyses as they had insufficient data 28–32 34–36 and 15 were included in the meta-analyses ( figure 1 ). 16–19 21–27 33 37–39 …”

Section: Resultsmentioning

confidence: 99%

“…Three papers report on the rates of intubation when comparing HFNC to CPAP 16 23 24 and suggest no significant difference (OR 1.78, 95% CI 0.68 to 4.69, p=0.92) ( online supplemental figure 2 ).…”

Section: Resultsmentioning

confidence: 99%

“…Fixed-effects model was used if there is a low chance of heterogenicity (<49%), and a random-effects model used for a high chance of heterogenicity. The method of Wan et al was Open access used to convert the medians to means where possible for included articles [16][17][18][19] reporting median values. 20…”

Section: Discussionmentioning

confidence: 99%

“…Four studies reported on treatment failure rates when comparing HFNC to CPAP. 16 23 24 39 The pooled data show no significant difference between CPAP and HFNC (OR 1.64, 95% CI 0.96 to 2.79; p=0.07) (figure 3). Heterogeneity was insignificant (I 2 =0%).…”

Section: Meta-analysis Of Outcomesmentioning

confidence: 96%

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Efficacy and safety of high flow nasal oxygen for children with bronchiolitis: systematic review and meta-analysis

et al. 2021

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BackgroundTo assess the published evidence to establish the efficacy and safety of high flow oxygen cannula (HFNC) as respiratory support for children up to 24 months of age with bronchiolitis within acute hospital settings.MethodsWe searched eight databases up to March 2021. Studies including children up to 24 months of age with a diagnosis of bronchiolitis recruited to an randomised controlled trial were considered in the full meta-analysis. At least one arm of the study must include HFNC as respiratory support and report at least one of the outcomes of interest. Studies were identified and extracted by two reviewers. Data were analysed using Review Manager V.5.4.ResultsFrom 2943 article titles, 308 full articles were screened for inclusion. 23 studies met the inclusion criteria, 15 were included in the metanalyses. Four studies reported on treatment failure rates when comparing HFNC to standard oxygen therapy (SOT). Data suggests HFNC is superior to SOT (OR 0.45, 95% CI 0.36 to 0.57). Four studies reported on treatment failure rates when comparing HFNC to continuous positive airways pressure (CPAP). No significant difference was found between CPAP and HFNC (OR 1.64, 95% CI 0.96 to 2.79; p=0.07). Four studies report on adverse outcomes when comparing HFNC to SOT. No significant difference was found between HFNC & SOT (OR 1.47, 95% CI 0.54 to 3.99).ConclusionHFNC is superior to SOT in terms of treatment failure and there is no significant difference between HFNC and CPAP in terms of treatment failure. The results suggest HFNC is safe to use in acute hospital settings.

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Section: Resultsmentioning

confidence: 99%

“… 16–19 21–39 8 were excluded from the meta-analyses as they had insufficient data 28–32 34–36 and 15 were included in the meta-analyses ( figure 1 ). 16–19 21–27 33 37–39 …”

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Meta-analysis Of Outcomesmentioning

confidence: 96%

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Efficacy and safety of high flow nasal oxygen for children with bronchiolitis: systematic review and meta-analysis

et al. 2021

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Effect of High-Flow Nasal Cannula Therapy vs Continuous Positive Airway Pressure Therapy on Liberation From Respiratory Support in Acutely Ill Children Admitted to Pediatric Critical Care Units

Ramnarayan

Richards-Belle

Drikite

et al. 2022

JAMA

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IMPORTANCEThe optimal first-line mode of noninvasive respiratory support for acutely ill children is not known.OBJECTIVE To evaluate the noninferiority of high-flow nasal cannula therapy (HFNC) as the first-line mode of noninvasive respiratory support for acute illness, compared with continuous positive airway pressure (CPAP), for time to liberation from all forms of respiratory support. DESIGN, SETTING, AND PARTICIPANTS Pragmatic, multicenter, randomized noninferiority clinical trial conducted in 24 pediatric critical care units in the United Kingdom among 600 acutely ill children aged 0 to 15 years who were clinically assessed to require noninvasive respiratory support, recruited between August 2019 and November 2021, with last follow-up completed in March 2022. INTERVENTIONS Patients were randomized 1:1 to commence either HFNC at a flow rate based on patient weight (n = 301) or CPAP of 7 to 8 cm H 2 O (n = 299). MAIN OUTCOMES AND MEASURESThe primary outcome was time from randomization to liberation from respiratory support, defined as the start of a 48-hour period during which a participant was free from all forms of respiratory support (invasive or noninvasive), assessed against a noninferiority margin of an adjusted hazard ratio of 0.75. Seven secondary outcomes were assessed, including mortality at critical care unit discharge, intubation within 48 hours, and use of sedation. RESULTSOf the 600 randomized children, consent was not obtained for 5 (HFNC: 1; CPAP: 4) and respiratory support was not started in 22 (HFNC: 5; CPAP: 17); 573 children (HFNC: 295; CPAP: 278) were included in the primary analysis (median age, 9 months; 226 girls [39%]). The median time to liberation in the HFNC group was 52.9 hours (95% CI, 46.0-60.9 hours) vs 47.9 hours (95% CI, 40.5-55.7 hours) in the CPAP group (absolute difference, 5.0 hours [95% CI -10.1 to 17.4 hours]; adjusted hazard ratio 1.03 [1-sided 97.5% CI, 0.86-ϱ]). This met the criterion for noninferiority. Of the 7 prespecified secondary outcomes, 3 were significantly lower in the HFNC group: use of sedation (27.7% vs 37%; adjusted odds ratio, 0.59 [95% CI, 0.39-0.88]); mean duration of critical care stay (5 days vs 7.4 days; adjusted mean difference, −3 days [95% CI, −5.1 to −1 days]); and mean duration of acute hospital stay (13.8 days vs 19.5 days; adjusted mean difference, −7.6 days [95% CI, −13.2 to −1.9 days]). The most common adverse event was nasal trauma (HFNC: 6/295 [2.0%]; CPAP: 18/278 [6.5%]).CONCLUSIONS AND RELEVANCE Among acutely ill children clinically assessed to require noninvasive respiratory support in a pediatric critical care unit, HFNC compared with CPAP met the criterion for noninferiority for time to liberation from respiratory support.

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High-flow nasal cannula therapy for infants with bronchiolitis

Armarego,

Forde,

Wills

et al. 2024

Cochrane Database of Systematic Reviews

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

Cited by 29 publications

References 31 publications

Efficacy and safety of high flow nasal oxygen for children with bronchiolitis: systematic review and meta-analysis

Efficacy and safety of high flow nasal oxygen for children with bronchiolitis: systematic review and meta-analysis

Effect of High-Flow Nasal Cannula Therapy vs Continuous Positive Airway Pressure Therapy on Liberation From Respiratory Support in Acutely Ill Children Admitted to Pediatric Critical Care Units

High-flow nasal cannula therapy for infants with bronchiolitis

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