High-Flow Nasal Cannula Therapy for Infants With Bronchiolitis

CLINICAL QUESTION

Does use of high-flow nasal cannula (HFNC) treatment in infants with bronchiolitis improve hospital length of stay and the need for treatment escalation?

EVIDENCE-BASED ANSWER

HFNC treatment is appropriate for infants younger than 24 months with bronchiolitis. Compared with low-flow oxygen, use of HFNC treatment results in a modest reduction in length of hospital stay (ie, by 0.65 days) and need for treatment escalation with no significant difference in adverse events.¹ (Strength of Recommendation: B, inconsistent or limited-quality patient-oriented evidence.)

PRACTICE POINTERS

Bronchiolitis is a common lower respiratory tract illness affecting infants younger than 24 months and is the most common cause of hospitalization in infants.¹ Conventional treatment includes intravenous fluids, supplemental oxygen, and respiratory support. The authors of this Cochrane review assessed the effects of HFNC treatment compared with conventional respiratory support in the care of infants with bronchiolitis.

This Cochrane review included 11 studies comparing HFNC treatment to low-flow oxygen therapy.¹ HFNC treatment was defined as heated, humidified oxygen delivered through a nasal cannula at greater than 4 L/min; most studies described using a weight-based formula with starting flow rates at 1 to 2 L/kg per minute. Low-flow oxygen was delivered via a range of devices, including nasal prongs, face mask, and head box. Participants were all younger than 24 months with clinically diagnosed bronchiolitis in various hospital settings. The primary outcomes evaluated were length of hospital stay and adverse events. The secondary outcomes analyzed included changes in mean respiratory rate, changes in mean heart rate, need for treatment escalation, and duration of oxygen therapy or other respiratory support.