High-flow oxygen therapy not superior to NIV/ LFOT as rescue therapy in kids

A new study published in Pediatric Critical Care Medicine suggests that high-flow oxygen therapy does not appear to be superior to low-flow oxygen therapy (LFOT) as an initial treatment or to noninvasive ventilation (NIV) as a rescue therapy.

In cases of acute respiratory failure, oxygen therapy administered using a face mask with a reservoir bag is typically used as the initial treatment. This approach, however, has a lot of restrictions and is unable to provide ventilation. Dry gas compromises comfort and limits the proportion of inspired oxygen (FiO2) given, which also reduces mucociliary clearance. NIV, albeit with mixed results, has been widely employed since the 1990s with a solid degree of evidence in cardiogenic pulmonary edema and chronic obstructive pulmonary disease (COPD) exacerbation. In order to determine the efficacy of noninvasive respiratory support strategies in bronchiolitis, Gutiérrez Moreno and colleagues present their systematic study.

Network meta-analyses of the clinical trials and pairwise meta-analyses of all papers were carried out for this study's systematic review. In randomized controlled trials (RCTs), non-RCTs, and cohort studies where high-flow nasal cannula (HFNC) was compared with traditional low-flow oxygen treatment and/or noninvasive ventilation, patients under 24 months old with bronchiolitis who need noninvasive respiratory support were included. For data extraction, hospitalized bronchiolitis patients and emergency rooms were utilized.

The key findings of this study were:

1. 8,385 participants from 14 non-RCT studies and 3,367 patients from 14 RCTs were combined for analysis.

2. There are no differences between HFNC and NIV in experimental investigations, but only in nonexperimental studies is HFNC linked to a decreased risk of invasive mechanical ventilation (MV) than NIV.

3. In terms of other outcomes, there were no variations between HFNC and NIV.

4. When it comes to lowering oxygen days and treatment failure, HFNC outperforms LFOT.

5. NIV was the most successful strategy in the network meta-analyses of clinical trials to prevent invasive MV and to decrease days under oxygen treatment, despite crossover effect estimates across strategies showing no significant differences.

6. The included studies demonstrate methodological variation, although only for the decrease of days of oxygen treatment and length of hospital stay is it statistically significant.

Reference:

Gutiérrez Moreno, M., del Villar Guerra, P., Medina, A., Modesto i Alapont, V., Castro Bournissen, L., Mirás Veiga, A., & Ochoa-Sangrador, C. (n.d.-a). High-flow oxygen and other noninvasive respiratory support therapies in bronchiolitis: Systematic review and network meta-analyses. Pediatric Critical Care Medicine. https://doi.org/10.1097/PCC.0000000000003139