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.