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High-flow nasal cannula therapy for children with bronchiolitis: a systematic review and meta-analysis
  1. Jilei Lin1,2,
  2. Yin Zhang1,2,
  3. Limei Xiong1,2,
  4. Sha Liu1,
  5. Caihui Gong1,
  6. Jihong Dai1,2
  1. 1 Respiratory Department, Children’s Hospital of Chongqing Medical University, Chongqing, China
  2. 2 Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
  1. Correspondence to Professor Jihong Dai, Respiratory Department, Children’s Hospital of Chongqing Medical University, Chongqing 400065, China; danieljh{at}


Objectives To review the effects and safety of high-flow nasal cannula (HFNC) for bronchiolitis.

Methods Six electronic databases including PubMed, EMBASE, Cochrane Central Register of Controlled Trials, China National Knowledge Infrastructure, CQ VIP Database and Wanfang Data were searched from their inception to 1 June 2018. Randomised controlled trials (RCTs) which investigated the effects of HFNC versus other forms of oxygen therapies for bronchiolitis were included.

Results Nine RCTs with 2121 children met the eligibility criteria. There was no significant difference in length of stay in hospital (LOS), length of oxygen supplementation (LOO), transfer to intensive care unit, incidence of intubation, respiratory rate, SpO2 and adverse events in HFNC group compared with standard oxygen therapy (SOT) and nasal continuous positive airway pressure (nCPAP) groups. A significant reduction of the incidence of treatment failure (risk ratio (RR) 0.50, 95% CI 0.40 to 0.62, p<0.01) was observed in HFNC group compared with SOT group, but there was a significant increase of the incidence of treatment failure (RR 1.61, 95% CI 1.06 to 2.42, p0.02) in HFNC group compared with nCPAP group. In subgroup analysis, LOS was significantly decreased in HFNC group compared with SOT group in low-income and middle-income countries.

Conclusion The systematic review suggests HFNC is safe as an initial respiratory management, but the evidence is still lacking to show benefits for children with bronchiolitis compared with SOT or nCPAP.

  • bronchiolitis
  • children
  • high-flow nasal cannula
  • meta-analysis

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  • Contributors JL is responsible for conception, data search, inclusion and exclusion of studies, data extraction, assessment of methodological quality, data analysis and writing the manuscript. YZ and CG is responsible for inclusion and exclusion of studies, data extraction and data analysis. LX and SL is responsible for data search, inclusion and exclusion of studies, assessment of methodological quality and checking the data of the outcomes. JD is responsible for supervision, interpretation of results and checking the first and the final versions of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.