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High-flow nasal cannula therapy for children with bronchiolitis: a systematic review and meta-analysis
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  • Published on: 1 March 2019
    Reply to Prof. Matti Korppi
    • Jihong Dai, Pediatrician Children’s hospital of Chongqing Medical University

    Thank you for your attention to this research. Firstly, this systematic review showed that LOS was decreased in the HFNC group comparing with SOT group in low-income and middle-income countries. As you mentioned in the letter that even in high-income countries, it’s not realistic to treat all bronchiolitis patients with HFNC during RSV peaks. The inconsistent result of LOS in different countries may be caused by the level of medical practice in different areas because the LOS in low-income and middle-income countries was significantly longer than in high-income countries. So the clinical heterogeneity suggested that the level of medical practice was also important for bronchiolitis. Secondly, two studies showed that patients with treatment failures in SOT group could be treated with HFNC in the wards. This meta-analysis showed that there was a significant increase in the incidence of treatment failure in HFNC group compared with nCPAP group (RR 1.61, 95% CI 1.06 to 2.42, p=0.02). Therefore, we need more research to explore which choice (HFNC or nCPAP) is better for patients with treatment failures in standard oxygen supplementation.

    Conflict of Interest:
    None declared.
  • Published on: 4 February 2019
    High-flow nasal cannula therapy in infant bronchiolitis
    • Matti Korppi, Professor Center for Child Health Research, Tampere University and University Hospital, Tampere, Finland
    • Other Contributors:
      • Paula Heikkilä, Research coordinator

    Lin et al. published a meta-analysis on high-flow nasal cannula therapy (HFNC) in 2121 children with bronchiolitis younger than 24 months1. Six randomised controlled trials (RCTs) compared HFNC with standard oxygen therapy (SOT) and three with nasal continuous positive airway pressure (nCPAP). There were no significant differences in primary outcomes between the groups: length of hospital stay (LOS), length of oxygen supplementation, and transfer to the paediatric intensive care unit (PICU). A significant reduction in treatment failures (RR 0.50, 95%CI 0.40-0.62) was observed in HFNC versus SOT group1, when two studies (1674 children) were included 2,3. However, there was a significant increase in treatment failures (RR 1.61, 95% CI 1.06-2.42) in HFNC versus nCPAP group1, when two studies (173 children) were included 4,5.
    HFNC therapies can be carried out on well-facilitated wards, and the need is greatest during respiratory syncytial virus (RSV) epidemics. The authors concluded that LOS was decreased in the HFNC group in low-income and middle-income countries 1. Even in high-income countries, it is not realistic to treat all bronchiolitis patients, who need oxygen, with HFNC during RSV peaks.
    Franklin et al. evaluated HFNC in a RCT including 1472 children with bronchiolitis admitted to 17 hospitals in Australia and New Zealand 2. The primary outcome, treatment failure, happened in 12% of HFNC and in 31% of SOT patients (p<0.001). The figures of failures we...

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    Conflict of Interest:
    None declared.