Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2014 Jan 20;2014(1):CD009609.
doi: 10.1002/14651858.CD009609.pub2.

High-flow nasal cannula therapy for infants with bronchiolitis

Sean Beggs  1 , Zee Hame Wong, Sheena Kaul, Kathryn J Ogden, Julia A E Walters
Affiliations

High-flow nasal cannula therapy for infants with bronchiolitis

Sean Beggs et al. Cochrane Database Syst Rev. .

Update in

Abstract

Background: Bronchiolitis is a common lower respiratory tract illness, usually of viral aetiology, affecting infants younger than 24 months of age and is a frequent cause of hospitalisation. It causes airway inflammation, mucus production and mucous plugging, resulting in airway obstruction. Effective pharmacotherapy is lacking and bronchiolitis is a major cause of morbidity and mortality.Conventional treatment consists of supportive therapy in the form of fluids, supplemental oxygen and respiratory support. Traditionally oxygen delivery is as a dry gas at 100% concentration via low-flow nasal prongs. However, the use of heated, humidified, high-flow nasal cannula (HFNC) therapy enables delivery of higher inspired gas flows of an air/oxygen blend, up to 12 L/min in infants and 30 L/min in children. Its use provides some level of continuous positive airway pressure to improve ventilation in a minimally invasive manner. This may reduce the need for invasive respiratory support thus potentially lowering costs, with clinical advantages and fewer adverse effects.

Objectives: To assess the effects of HFNC therapy compared with conventional respiratory support in the treatment of infants with bronchiolitis.

Search methods: We searched CENTRAL (2013, Issue 4), MEDLINE (1946 to May week 1, 2013), EMBASE (January 2010 to May 2013), CINAHL (1981 to May 2013), LILACS (1982 to May 2013) and Web of Science (1985 to May 2013). In addition we consulted ongoing trial registers and experts in the field to identify ongoing studies, checked reference lists of relevant articles and searched conference abstracts.

Selection criteria: We included randomised controlled trials (RCTs) or quasi-RCTs which assessed the effects of HFNC (delivering oxygen or oxygen/room air blend at flow rates greater than 4 L/min) compared to conventional treatment in infants (< 24 months) with a clinical diagnosis of bronchiolitis.

Data collection and analysis: Two review authors independently used a standard template to assess trials for inclusion and extract data on study characteristics, 'Risk of bias' elements and outcomes. We contacted trial authors to request missing data. Outcome measures included the need for invasive respiratory support and time until discharge, clinical severity measures, oxygen saturation, duration of oxygen therapy and adverse events.

Main results: We included one RCT which was a pilot study with 19 participants that compared HFNC therapy with oxygen delivery via a head box. In this study, we judged the risk of selection, attrition and reporting bias to be low, and we judged the risk of performance and detection bias to be unclear due to lack of blinding. The median oxygen saturation (SpO2) was higher in the HFNC group at eight hours (100% versus 96%, P = 0.04) and at 12 hours (99% versus 96%, P = 0.04) but similar at 24 hours. There was no clear evidence of a difference in total duration of oxygen therapy, time to discharge or total length of stay between groups. No adverse events were reported in either group and no participants in either group required further respiratory support. Five ongoing trials were identified but no data were available in May 2013. We were not able to perform a meta-analysis.

Authors' conclusions: There is insufficient evidence to determine the effectiveness of HFNC therapy for treating infants with bronchiolitis. The current evidence in this review is of low quality, from one small study with uncertainty about the estimates of effect and an unclear risk of performance and detection bias. The included study provides some indication that HFNC therapy is feasible and well tolerated. Further research is required to determine the role of HFNC in the management of bronchiolitis in infants. The results of the ongoing studies identified will contribute to the evidence in future updates of this review.

PubMed Disclaimer

Conflict of interest statement

None declared.

Figures

1
1
Study flow diagram.
2
2
'Risk of bias' summary: review authors' judgements about each risk of bias item for each included study.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

References to studies included in this review

Hilliard 2012 {published data only}
    1. Archer N, Cottis H, Ball S, Mills K, Hilliard T. A pilot randomised controlled study of oxygen delivery via vapotherm in infants with moderately severe acute bronchiolitis [Abstract]. European Respiratory Society Annual Congress, Vienna, Austria, September 12‐16 2009. 2009:P4002.
    1. Hilliard TN, Archer N, Laura H, Heraghty J, Cottis H, Mills K, et al. Pilot study of vapotherm oxygen delivery in moderately severe bronchiolitis. Archives of Disease in Childhood 2012;97:182‐3. - PubMed

References to studies excluded from this review

Bajaj 2006 {published data only}
    1. Bajaj L, Bothner J, Turner C. A randomized trial of home oxygen therapy from the emergency department for acute bronchiolitis ‐ In reply. Pediatrics 2006;118:1320‐1. - PubMed
    1. Bajaj L, Turner CG, Bothner J. A randomized trial of home oxygen therapy from the emergency department for acute bronchiolitis. Pediatrics 2006;117:633‐40. - PubMed
Balanzat 2006 {published data only}
    1. Balanzat AMC, Lazarte G, Surarez V, Bonilla ME, Gighi M, Chede C, et al. Effects of different levels of nasal continuous positive airways pressure (CPAP) in infants with severe acute bronchiolitis [Abstract]. European Respiratory Journal 2006;28:264s [P1531].
Blyth 2003 {published data only}
    1. Blyth TP, Kozlowska W, McKenzie SA, Carr SB. Randomised controlled trial of CPAP in severe bronchiolitis [abstract]. Thorax 2003;58:iii68.
Donlan 2011 {published data only}
    1. Donlan M, Fontela PS, Puligandla PS. Use of continuous positive airway pressure (CPAP) in acute viral bronchiolitis: a systematic review. Pediatric Pulmonology 2011;46:736‐46. - PubMed
Figueruelo 2011 {published data only}
    1. Figueruelo AG, Villaescusa JU, Prieto MB, Garcia MJS, Bartolome SM, Cid JLH. Use of high‐flow nasal cannula for non‐invasive ventilation in children. Anales De Pediatria 2011;75:182‐7. - PubMed
Hough 2011 {published data only}
    1. Hough JL, Pham TMT, Schibler A. Delivery of high flow nasal prong oxygen: the effect CPAP exposed. Pediatric Critical Care Medicine 2011;12:A7.
Kim 2011 {published data only}
    1. Kim IK, Phrampus E, Sikes K, Pendleton J, Saville A, Corcoran T, et al. Helium‐oxygen therapy for infants with bronchiolitis: a randomized controlled trial. Archives of Pediatrics & Adolescent Medicine 2011;165:1115‐22. - PubMed
Martinón‐Torres 2002 {published data only}
    1. Martinón‐Torres F, Rodríguez‐Núñez A, Martinón‐Sánchez JM. Heliox therapy in infants with acute bronchiolitis. Pediatrics 2002;109:68‐73. - PubMed
Martinon‐Torres 2003 {published data only}
    1. Martinon‐Torres F. Current treatment for acute viral bronchiolitis in infants. Expert Opinion on Pharmacotherapy 2003;4:1355‐71. - PubMed
Martinon‐Torres 2008 {published data only}
    1. Martinon‐Torres F, Rodriguez‐Nunez A, Martinon‐Sanchez JM. Nasal continuous positive airway pressure with heliox versus air oxygen in infants with acute bronchiolitis: a crossover study. Pediatrics 2008;121:e1190‐5. - PubMed
Milesi 2010 {published data only}
    1. Milesi C, Ferragu F, Jacquot A, Pidoux O, Chautemp N, Mesnage R, et al. Randomized comparison between nasal continuous positive airway pressure (NCPAP) and conventional nasal oxygen delivery on respiratory muscle load and respiratory distress syndrome in young infants with severe acute bronchiolitis. Fundamental and Clinical Pharmacology 2010;24:106.
    1. Milesi C, Ferragu F, Jacquot A, Pidoux O, Chautemps N, Mesnage R, et al. Randomized comparison between nasal continuous positive airway pressure (NCPAP) and conventional nasal oxygen delivery on respiratory muscle load and respiratory distress syndrome in young infants with severe acute bronchiolitis [Abstract]. American Journal of Respiratory and Critical Care Medicine 2010;181:A6057.
Smith 1993 {published data only}
    1. Smith PG, el‐Khatib MF, Carlo WA. PEEP does not improve pulmonary mechanics in infants with bronchiolitis. American Review of Respiratory Disease 1993;147:1295‐8. - PubMed
Tie 2009 {published data only}
    1. Tie SW, Hall GL, Peter S, Vine J, Verheggen M, Pascoe EM, et al. Home oxygen for children with acute bronchiolitis. Archives of Disease in Childhood 2009;94:641‐3. - PubMed
Unger 2008 {published data only}
    1. Unger S, Cunningham S. Effect of oxygen supplementation on length of stay for infants hospitalized with acute viral bronchiolitis. Pediatrics 2008;121:470‐5. - PubMed

References to ongoing studies

Kepreotes 2012 {unpublished data only}
    1. Elizabeth Kepreotes, Clinical Improvement Co‐ordinator, John Hunter Children's Hospital, Newcastle, NSW, Australia.
Milner 2012 {unpublished data only}
    1. Donna M. Milner, Emergency Department Children's Hospitals and Clinics of Minnesota, 345 North Smith AveSt. Paul, MN, 55102, USA.
Schibler 2013 {unpublished data only}
    1. A/Prof Andreas Schibler, Mater Children's Hospital Paediatric Intensive Care Unit, Stanely Street, South Brisbane, 4101, QLD, Australia.
Seear 2011 {unpublished data only}
    1. Michael Seear, British Columbia Children's Hospital, Vancouver, British Columbia, V6H 3N1, Canada.
Sood 2012 {published data only (unpublished sought but not used)}
    1. Sood R, Stolfi A, Rowin ME. Use of high flow high humidity nasal cannula therapy for infants with bronchiolitis. Journal of Investigative Medicine 2012;60(1):515.
Whitehall 2012 {unpublished data only}
    1. John Whitehall, Department of Paediatrics, School of Medicine, Campbelltown Campus, University of Western Sydney, Locked Bag 1797, Penrith, NSW, 2751, Australia.

Additional references

AAPS 2006
    1. American Academy of Pediatrics Subcommittee on Diagnosis Management of Bronchiolitis. Diagnosis and management of bronchiolitis. Pediatrics 2006;118(4):1774‐93. - PubMed
Abboud 2012
    1. Abboud PA, Roth PJ, Skiles CL, Stolfi A, Rowin ME. Predictors of failure in infants with viral bronchiolitis treated with high‐flow, high‐humidity nasal cannula therapy. Pediatric Critical Care Medicine 2012;13(6):e343‐9. - PubMed
De Klerk 2008
    1. Klerk A. Humidified high‐flow nasal cannula: is it the new and improved CPAP?. Advances in Neonatal Care 2008;8(2):98‐106. - PubMed
Deeks 2011
    1. Deeks JJ, Higgins JPT, Altman DG (editors). Chapter 9: Analysing data and undertaking meta‐analyses. In: Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions. Version 5.1.0 [updated March 2011]. The Cochrane Collaboration. In: Higgins JPT, Green S editor(s). Available from www.cochrane‐handbook.org. Chichester, UK: Wiley‐Blackwell, 2011.
Dysart 2009
    1. Dysart K, Miller TL, Wolfson MR, Shaffer TH. Research in high flow therapy: mechanisms of action. Respiratory Medicine 2009;103(10):1400‐5. - PubMed
Fernandes 2013
    1. Fernandes RM, Bialy LM, Vandermeer B, Tjosvold L, Plint AC, Patel H, et al. Glucocorticoids for acute viral bronchiolitis in infants and young children. Cochrane Database of Systematic Reviews 2013, Issue 6. [DOI: 10.1002/14651858.CD004878.pub4] - DOI - PMC - PubMed
Gadomski 2010
    1. Gadomski AM, Brower M. Bronchodilators for bronchiolitis. Cochrane Database of Systematic Reviews 2010, Issue 12. [DOI: 10.1002/14651858.CD001266.pub3] - DOI - PubMed
Guyatt 2008
    1. Guyatt GH, Oxman AD, Vist GE, Kunz R, Falck‐Ytter Y, Alonso‐Coello P, et al. GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ 2008;336(7650):924‐6. - PMC - PubMed
Hall 2009
    1. Hall CB, Weinberg GA, Iwane MK, Blumkin AK, Edwards KM, Staat MA, et al. The burden of respiratory syncytial virus infection in young children. New England Journal of Medicine 2009;360(6):588‐98. - PMC - PubMed
Hartling 2011
    1. Hartling L, Bialy LM, Vandermeer B, Tjosvold L, Johnson DW, Plint AC, et al. Epinephrine for bronchiolitis. Cochrane Database of Systematic Reviews 2011, Issue 6. [DOI: 10.1002/14651858.CD003123.pub3] - DOI - PubMed
Higgins 2011
    1. Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions. Version 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011. Available from www.cochrane‐handbook.org.
Kubicka 2008
    1. Kubicka ZJ, Limauro J, Darnall RA. Heated, humidified high‐flow nasal cannula therapy: yet another way to deliver continuous positive airway pressure?. Pediatrics 2008;121(1):82‐8. - PubMed
Kusel 2006
    1. Kusel M, Klerk N, Holt PG, Kebadze T, Johnston S, Sly P. Role of respiratory viruses in acute upper and lower respiratory tract illness in the first year of life: a birth cohort study. Pediatric Infectious Disease Journal 2006;25(8):680‐6. - PubMed
Lampland 2009
    1. Lampland A, Plumm B, Meyers P, Worwa C, Mammel M. Observational study of humidified high‐flow nasal cannula compared with nasal continuous positive airway pressure. Journal of Pediatrics 2009;154(2):177‐82. - PubMed
Lee 2012
    1. Lee JH, Rehder KJ, Williford L, Cheifetz IM, Turner DA. Use of high flow nasal cannula in critically ill infants, children, and adults: a critical review of the literature. Intensive Care Medicine 2012;39(2):247‐57. [DOI: 10.1007/s00134-012-2743-5] - DOI - PubMed
Lefebvre 2011
    1. Lefebvre C, Manheimer E, Glanville J. Chapter 6: Searching for studies. In: Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions. Version 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011. Available from www.cochrane‐handbook.org.
McKiernan 2010
    1. McKiernan C, Chua LC, Visintainer AF, Allen H. High flow nasal cannulae therapy in infants with bronchiolitis. Journal of Pediatrics 2010;156(4):634‐8. - PubMed
Milesi 2013
    1. Milesi C, Baleine J, Matecki S, Durand S, Combes C, Rideau Batista Novais A, et al. Is treatment with a high flow nasal cannula effective in acute viral bronchiolitis? A physiologic study. Intensive Care Medicine 2013;39(6):1170. - PubMed
Pelletier 2006
    1. Pelletier AJ, Mansbach JM, Camargo CA Jr. Direct medical costs of bronchiolitis hospitalizations in the United States. Pediatrics 2006;118(6):2418‐23. - PubMed
RevMan 2012 [Computer program]
    1. The Nordic Cochrane Centre, The Cochrane Collaboration. Review Manager (RevMan). Version 5.2. Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration, 2012.
Schibler 2011
    1. Schibler A, Pham T, Dunster K, Foster K, Barlow A, Gibbons K, et al. Reduced intubation rates for infants after introduction of high‐flow nasal prong oxygen delivery. Intensive Care Medicine 2011;37(5):847‐52. - PubMed
Shay 1999
    1. Shay DK, Holman RC, Newman RD, Liu LL, Stout JW, Anderson LJ. Bronchiolitis‐associated hospitalizations among US children, 1980‐1996. JAMA 1999;282(15):1440‐6. - PubMed
Spence 2007
    1. Spence KL, Murphy D, Kilian C, McGonigle R, Kilani RA. High‐flow nasal cannula as a device to provide continuous positive airway pressure in infants. Journal of Perinatology 2007;27(12):772. - PubMed
Spentzas 2009
    1. Spentzas T, Minarik M, Patters AB, Vinson B, Stidham G. Children with respiratory distress treated with high‐flow nasal cannula. Journal of Intensive Care Medicine 2009;24(5):323‐8. - PubMed
Spurling 2011
    1. Spurling GKP, Doust J, Mar CB, Eriksson L. Antibiotics for bronchiolitis in children. Cochrane Database of Systematic Reviews 2011, Issue 6. [DOI: 10.1002/14651858.CD005189.pub3] - DOI - PubMed
Vicencio 2010
    1. Vicencio AG. Susceptibility to bronchiolitis in infants. Current Opinion in Pediatrics 2010;22(3):302‐6. - PubMed

Publication types