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Meta-Analysis
. 2021 Jul;8(1):e000844.
doi: 10.1136/bmjresp-2020-000844.

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

Carwyn Dafydd  1 , Benjamin J Saunders  1 , Sarah J Kotecha  2 , Martin O Edwards  3   2
Affiliations
Meta-Analysis

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

Carwyn Dafydd et al. BMJ Open Respir Res. 2021 Jul.

Abstract

Background: To 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.

Methods: We 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.

Results: From 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).

Conclusion: HFNC 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.

Keywords: non invasive ventilation; respiratory infection.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Study selection results.
Figure 2
Figure 2
Comparison of high-flow nasal cannula (HFNC) versus SOT and Oxymask: treatment failure. M-H, Mantel-Haenszel; SOT, standard oxygen therapy.
Figure 3
Figure 3
Comparison of high-flow nasal cannula (HFNC) versus CPAP outcome: treatment failure. CPAP, continuous positive airways pressure; M-H, Mantel-Haenszel.
Figure 4
Figure 4
Comparison of high-flow nasal cannula (HFNC) versus SOT and HSS outcome: rates of admission to PICU. M-H, Mantel-Haenszel; PICU, paediatric intensive care unit; SOT, standard oxygen therapy.
Figure 5
Figure 5
Comparison of high-flow nasal cannula (HFNC) versus SOT, Oxymask and HSS outcome: total length of stay days. SOT, standard oxygen therapy.
Figure 6
Figure 6
Comparison of high-flow nasal cannula (HFNC) versus SOT and HSS outcome: adverse effects. M-H, Mantel-Haenszel; SOT, standard oxygen therapy.
Figure 7
Figure 7
Comparison of high-flow nasal cannula (HFNC) versus SOT on the wards: treatment failure. M-H, Mantel-Haenszel; SOT, standard oxygen therapy.
Figure 8
Figure 8
Comparison of high-flow nasal cannula (HFNC) versus SOT on the wards: total O2 therapy in days. SOT, standard oxygen therapy.
See this image and copyright information in PMC

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