Effectiveness of high-flow oxygen therapy in a second-level hospital in bronchiolitis

Abstract

Introduction: To estimate the impact of the incorporation of high-flow nasal cannule (HFNC) in patients admitted with acute bronchiolitis in a hospital without pediatric intensive care unit (PICU).

Material and methods: Cohort study with historical control of bronchiolitis in a second-level hospital, before (2009-2012) and after (2015-2020) the implementation of HFNC. The main outcome was the need for admission to the PICU.

Results: 301 patients were included. Respiratory syncytial viruses were identified in 64.7% of them and influenza viruses in 0.3%. No differences in age nor comorbility between periods were observed. The average stay was 3.67 days (standard deviation [SE] 2.10) in the first period and 4.00 days (SE 2.35) in the second. Three patients were transferred to UCIP (2.6%) before the availability of HFCN and 13 patients (9.4%) after, which supposed an important increase of the risk (relative risk 3.58; confidence interval [CI] 95%: 1.04-12.27), although not significant in adjusted analyses (Odds ratio 3.48; IC95% 0.95-12.72). A significant increase in readmission risk was also observed (from 5.3%-13.7%) and a shortening of the time to transfer.

Conclusions: The incorporation of HFNC was not associated with a lower risk of transfer to PICU nor a shorter length of oxygen therapy. In the absence of evidence, that supports the effectiveness and efficiency of the HFNC and establishes its indications, we must reassess its use.

Keywords: Bronchiolitis; Bronquiolitis; High-flow oxygen therapy; Non-invasive ventilation; Oxigenoterapia bajo flujo; Oxigenoterapia de alto flujo; Oxygen therapy; Pediatric intensive care unit; Unidad de cuidados intensivos pediátricos; Ventilación no invasiva.