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

Abstract

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.

Vitamin D Levels and Cardiopulmonary Status in Infants with Acute Bronchiolitis: Tip of the Iceberg?

“…Thus, the low incidence of VDD in studies showing no correlation between the severity of disease and vitamin D [1,2] is a significant limitation to consider when interpreting their results. Conversely, studies with larger sizes and higher rates of VDD [3,4] had conclusions similar to ours [1]. We also agree with the comment about the relevance of age and prematurity on the severity of acute bronchiolitis.…”

“…Another issue we want to draw attention to is that the NIV was used with a high frequency of 25% in this study [1], but the details about the NIV methods are lacking. A meta-analysis of 15 studies [4] showed that high-flow nasal oxygen therapy is beneficial and safe, with similar failure rates with continuous positive airway pressure. Secondly, bi-level positive pressure ventilation has been reported to be associated with longer PICU stay and prolonged ventilation needs [5].…”

RSV bronchiolitis season 2021 has arrived, so be prepared!

“…Appropriate resource allocation and preparation is needed now, with changes in departments needed akin to how we prepared for the surges in COVID-19 infections. This should include redeployment of clinical staff to manage the increased numbers of patients, up-to-date training on bronchiolitis guidelines, including use of highflow oxygen on acute paediatric wards, 6 and public health advice to reinforce the importance of NPI practices such as handwashing to reduce the spread of RSV.…”

Treatment of the most common respiratory infections in children

“…Recent data suggest beneficial effects of high-flow nasal cannula (HFNC), which combines the administration of oxygen with the application of positive airway pressure, all of which decreases work of breathing and improves gas exchange. HFNC therapy should be performed in highdependency units or ICU (90).…”