Efficacy of high-flow nasal cannula for respiratory distress in children

Takeaway

• High-flow nasal cannula (HFNC) reduced treatment failure in children aged <5 years with respiratory distress and mild hypoxaemia from bronchiolitis and pneumonia compared with standard therapy.
• However, when compared with nasal continuous positive airway pressure (nCPAP), HFNC was associated with higher treatment failure in infants aged 1-6 months with moderate-to-severe respiratory distress from bronchiolitis, pneumonia, sepsis, asthma and upper airway obstruction.

Why this matters

• Observational studies have suggested that HFNC may improve oxygenation and reduce the need for mechanical ventilation in children with respiratory distress.

Study design

• Meta-analysis of 8 randomised controlled studies including 2259 patients who were assigned to HFNC (n=1100), standard oxygen (n=980) or nCPAP (n=179) therapy after a search across PubMed, Embase, Medline, and other electronic databases.
• Main outcome: probability of treatment failure.
• Funding: None.

Key results

• HFNC vs standard oxygen therapy significantly reduced the probability of treatment failure (risk ratio [RR], 0.49; 95% CI, 0.40-0.60; P<.001) in children aged <5 years with mild hypoxaemia from bronchitis or pneumonia.
  • After stratification for age, HFNC was superior to standard therapy for:
    • infants aged 1-6 months: RR, 0.53; 95% CI, 0.40-0.69; P<.001,
    • infants aged 6-12 months: RR, 0.47; 95% CI, 0.33-0.67; P<.001 and
    • children aged 1-5 years: RR, 0.37; 95% CI, 0.16-0.83; P=.02.
• HFNC vs nCPAP showed an increased risk for treatment failure (RR, 1.74; 95% CI, 1.20-2.52; P=.004) in children with moderate-to-severe respiratory distress from bronchiolitis and pneumonia.
  • After stratification for age, nCPAP was superior to HFNC therapy for:
    • infants aged 1-6 months: RR, 1.77; 95% CI, 1.17-2.67; P=.007,
    • infants aged 6-12 months: RR, 1.46; 95% CI, 0.30-7.17; P=.64 and 
    • children aged 1-5 years: RR, 0.74; 95% CI, 0.07-7.63; P=.80.
• No significant differences were observed for intubation rates and mortality between HFNC and standard oxygen therapy or nCPAP (RR, 0.97; 95% CI, 0.56-1.68; P=.91).
• HFNC vs nCPAP showed a reduced risk for nasal trauma (RR, 0.35; 95% CI, 0.16-0.77; P=.009).

Limitations

• Limited number of studies.
• Risk of heterogeneity.