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High flow nasal cannula as respiratory support in treating infant bronchiolitis: a systematic review

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Abstract

Bronchiolitis is a common respiratory illness in early childhood, often leading to hospitalization and associated healthcare costs. Low flow 100% oxygen through nasal prongs is the standard therapy for infants with bronchiolitis and hypoxemia. Nasal continuous positive airway pressure (nCPAP) or invasive ventilation is used in case of progressive respiratory failure. High flow heated and humidified oxygen therapy with delivery of an air-oxygen mixture up to 2 L/min/kg body weight via nasal prongs (referred to as high flow nasal cannula or HFNC) is a newer method for respiratory support. Initial data from retrospective studies were promising but should be interpreted with caution. A limited number of prospective randomized controlled trials (RCT) have now compared HFNC with either standard oxygen therapy (SOT) or nCPAP. In this review, we critically summarize the data from these RCTs with the aim to provide advice on how to position HFNC in clinical practice.

Conclusion: HFNC is a safe mode of respiratory support that can be positioned between SOT and nCPAP as rescue therapy for children not adequately supported by SOT. It does not seem to shorten the duration of oxygen need nor the duration of hospital admission.

What is Known:

• HFNC is being used increasingly in the context of infant bronchiolitis. However, evidence on efficacy and safety are limited. Different published studies involve different disease severities and different pediatric settings.

What is New:

• In this review, we summarize data only from prospective RCTs with the aim to provide guidance on how to use HFNC.

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Abbreviations

HFNC:

High-flow nasal cannula oxygen therapy

LOS:

Length of stay

nCPAP:

Nasal continuous positive airway pressure

NIV:

Non-invasive ventilation

PICU:

Pediatric intensive care unit

RCT:

Randomized controlled trial

SOT:

Standard oxygen therapy

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Authors and Affiliations

  1. Department of Internal Medicine, University Hospitals Leuven, Leuven, Belgium

    Lien Moreel

  2. Department of Pediatrics, University Hospitals Leuven, Leuven, Belgium

    Marijke Proesmans

Authors
  1. Lien Moreel
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  2. Marijke Proesmans
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Contributions

MP is responsible for conception. LM performed the data search, in- and exclusion of studies, data extraction, assessment of methodological quality, data analysis, and writing the first manuscript draft. Supervision, interpretation of results, and help with every version of the manuscript were done by MP.

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Correspondence to Marijke Proesmans.

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The authors declare that they have no conflict of interest.

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This article does not contain any studies with human participants or animals performed by any of the authors.

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Responsible editor: Peter de Winter

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Moreel, L., Proesmans, M. High flow nasal cannula as respiratory support in treating infant bronchiolitis: a systematic review. Eur J Pediatr 179, 711–718 (2020). https://doi.org/10.1007/s00431-020-03637-0

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  • DOI: https://doi.org/10.1007/s00431-020-03637-0

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