High-Flow Oxygen and Other Noninvasive Respiratory Support Therapies in Bronchiolitis: Systematic Review and Network Meta-Analyses

Abstract

We present a systematic review on the effectiveness of noninvasive respiratory support techniques in bronchiolitis.DATA SOURCES: Systematic review with pairwise meta-analyses of all studies and network meta-analyses of the clinical trials. STUDY SELECTION:Patients below 24 months old with bronchiolitis who require noninvasive respiratory support were included in randomized controlled trials (RCTs), non-RCT, and cohort studies in which high-flow nasal cannula (HFNC) was compared with conventional low-flow oxygen therapy (LFOT) and/or noninvasive ventilation (NIV). DATA EXTRACTION: Emergency wards and hospitalized patients with bronchiolitis.DATA SYNTHESIS: A total of 3,367 patients were analyzed in 14 RCTs and 8,385 patients in 14 non-RCTs studies. Only in nonexperimental studies, HFNC is associated with a lower risk of invasive mechanical ventilation (MV) than NIV (odds ratio, 0.49; 95% CI, 0.42-0.58), with no differences in experimental studies. There were no differences between HFNC and NIV in other outcomes. HFNC is more effective than LFOT in reducing oxygen days and treatment failure. In the network meta-analyses of clinical trials, NIV was the most effective intervention to avoid invasive MV (surface under the cumulative ranking curve [SUCRA], 57.03%) and to reduce days under oxygen therapy (SUCRA, 79.42%), although crossover effect estimates between interventions showed no significant differences. The included studies show methodological heterogeneity, but it is only statistically significant for the reduction of days of oxygen therapy and length of hospital stay. CONCLUSIONS:Experimental evidence does not suggest that high-flow oxygen therapy has advantages over LFOT as initial treatment nor over NIV as a rescue treatment.

Nasal CPAP in the Pediatric Ward to Reduce PICU Admissions for Severe Bronchiolitis?

“…In both situations, the switch to using an HFNC was decided upon after an unsatisfactory correction of hypoxemia with conventional O 2 administration and a progressive worsening of respiratory distress were observed. Despite their increasing use in treating bronchiolitis, the definitive role of HFNCs is still debated with regard to their efficacy in reducing the duration of O 2 administration and the length of hospitalization and in preventing clinical worsening and the need for more intensive care [ 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 ]. Currently, HFNCs should be reserved for cases of failure of conventional O 2 therapy [ 23 , 46 ].…”

Trattare la bronchiolite con nCPAP nelle Pediatrie per “proteggere” le Terapie Intensive pediatriche?

“…In entrambe le situazioni il passaggio all'HFNC era stato deciso per l'insoddisfacente correzione dell'ipossiemia con O2 convenzionale e per il progressivo peggioramento del distress respiratorio. Nonostante il sempre più diffuso impiego nella bronchiolite, il ruolo definitivo dell'HFNC è ancora discusso in letteratura, con particolare riguardo all'efficacia nel ridurre i tempi di somministrazione dell'O2 e la durata della degenza e alla capacità di prevenire il peggioramento clinico e il possibile ricorso alla terapia intensiva 15,[35][36][37][38][39][40][41] . Allo stato attuale delle conoscenze, l'HFNC dovrebbe essere riservata ai casi di fallimento della terapia convenzionale con O2 1 .…”

Editor’s Choice Articles for February

“…Third, it is back to the all-important topic of bronchiolitis and supportive respiratory care. We have two systematic reviews: one on noninvasive ventilation (NIV) in acute respiratory failure–four of 15 articles were about bronchiolitis care (15); the other on use of high-flow nasal cannula (HFNC) oxygen therapy or NIV in 28 reports of bronchiolitis (16). We also have a retrospective study of oxygen exposure during IMV in 176 patients with bronchiolitis, in which the authors are interested in oxygen overuse and the potential for optimal oxygenation targets (17).…”