Vicent Modesto i Alapont (Spain)
Hospital Universitario La Fe de Valencia PICUAuthor Of 6 Presentations
Take away messages
HIGH FLOW NASAL CANNULA IN BRONCHIOLITIS: SYSTEMATIC REVIEW AND NETWORK META-ANALYSES:
Abstract
Background and Aims
BACKGROUND AND AIMS:
The medical treatment in bronchiolitis is based in respiratory support. There has been an increase in the use of high flow nasal cannula (HFNC), despite the lack of evidence on its advantages over conventional oxygen therapy and non-invasive ventilation (NIV). The objective is to perform a systematic review on the efficacy of HFNC in bronchiolitis.
Methods
METHODS:
A search was carried out of clinical trials in which HFNC was compared with conventional oxygen therapy (LFOT) and/or NIV in bronchiolitis. Paired meta-analyses and network meta-analyses were performed, with subgroup analyses according to study setting. The main outcome was invasive mechanical ventilation (IMV).
Results
RESULTS:
In the paired meta-analyses, there were no differences in the risk of IMV between HFNC and LFOT (Odds Ratio [OR] 1.79, 95% confidence interval [CI] 0.59 to 5.41) nor between HFNC and NIV (OR 1.77, 95% CI 0.67 to 4.69). HFNC was more effective than LFOT in reducing treatment failure and oxygen days. In the network meta-analyses, NIV was the most effective intervention to avoid IMV (SUCRA 86.55%), as well as to avoid treatment failure (SUCRA 95.31%) and to reduce days under oxygen therapy (SUCRA 81.84%); HFNC only was superior to LFOT for treatment failure outcome.
Conclusions
CONCLUSIONS:
HFNC appears to be more effective than LFOT in reducing treatment failure and days under oxygen therapy, but not in preventing IMV or admission to pediatric intensive care unit (PICU). NIV is the most effective treatment to prevent IMV and reduce days under oxygen therapy.