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

  • Luo J & al.
  • J Pediatr
  • 1 Dec 2019

  • curated by Sarfaroj Khan
  • UK Clinical Digest
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Takeaway

  • High-flow nasal cannula (HFNC) reduced treatment failure in children aged
  • 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 years with mild hypoxaemia from bronchitis or pneumonia. style="list-style-type:circle;">
  • 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.