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Review
. 2025 Nov;114(11):2743-2762.
doi: 10.1111/apa.70212. Epub 2025 Jul 2.

High Flow Nasal Cannula and Non Invasive Ventilation for Acute Bronchiolitis in the Paediatric Wards

Luca Pierantoni  1 , Giacomo Stera  2 , Carlotta Biagi  1 , Arianna Dondi  1 , Lawrence M Scheier  3   4 , Marcello Lanari  1
Affiliations
Review

High Flow Nasal Cannula and Non Invasive Ventilation for Acute Bronchiolitis in the Paediatric Wards

Luca Pierantoni et al. Acta Paediatr. 2025 Nov.

Abstract

Aim: Bronchiolitis is a leading cause of respiratory distress and hospital admissions in infants. While high-flow nasal cannula is effective for patients unresponsive to standard oxygen therapy, evidence regarding continuous positive airway pressure and noninvasive ventilation in the wards remains inconclusive. This review explores the feasibility and criteria for initiation, titration, and monitoring of high-flow nasal cannula, continuous positive airway pressure, and noninvasive ventilation in infants with bronchiolitis in paediatric wards.

Methods: Narrative review of studies from PubMed and the Cochrane Library (2000-2024), focusing on high-flow nasal cannula, continuous positive airway pressure, and noninvasive ventilation in bronchiolitis, particularly in paediatric wards.

Results: High-flow nasal cannula is widely used in paediatric wards as a safe and effective option for bronchiolitis. Evidence for continuous positive airway pressure and noninvasive ventilation outside intensive care is limited but suggests potential to reduce escalation in selected cases.

Conclusion: Continuous positive airway pressure and noninvasive ventilation in paediatric wards appear to carry limited safety concerns. While not proven superior to high-flow nasal cannula or standardised in their use, when applied selectively with trained staff and close monitoring, they may serve as rescue therapies. Better understanding of current evidence may support standardisation and improve resource allocation.

Keywords: high flow nasal cannula; invasive mechanical ventilation; noninvasive ventilation; paediatric intensive care unit; respiratory failure.

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