Update on the Role of High-Flow Nasal Cannula in Infants with Bronchiolitis
Bronchiolitis (BR), a lower respiratory tract infection mainly caused by respiratory syncytial virus (RSV), can be very severe. Presently, adequate nutritional support and oxygen therapy remain the only interventions recommended to treat patients with BR. For years, mild BR cases were treated with n...
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doaj-804e4327d45346fd99137b83eb9a18922021-04-02T16:49:54ZengMDPI AGChildren2227-90672021-01-018666610.3390/children8020066Update on the Role of High-Flow Nasal Cannula in Infants with BronchiolitisValentina Fainardi0Lara Abelli1Maria Muscarà2Giovanna Pisi3Nicola Principi4Susanna Esposito5Pediatric Clinic, Pietro Barilla Children’s Hospital, Department of Medicine and Surgery, University of Parma, 43126 Parma, ItalyPediatric Clinic, Pietro Barilla Children’s Hospital, Department of Medicine and Surgery, University of Parma, 43126 Parma, ItalyPediatric Clinic, Pietro Barilla Children’s Hospital, Department of Medicine and Surgery, University of Parma, 43126 Parma, ItalyPediatric Clinic, Pietro Barilla Children’s Hospital, Department of Medicine and Surgery, University of Parma, 43126 Parma, ItalyUniversità degli Studi di Milano, 20122 Milan, ItalyPediatric Clinic, Pietro Barilla Children’s Hospital, Department of Medicine and Surgery, University of Parma, 43126 Parma, ItalyBronchiolitis (BR), a lower respiratory tract infection mainly caused by respiratory syncytial virus (RSV), can be very severe. Presently, adequate nutritional support and oxygen therapy remain the only interventions recommended to treat patients with BR. For years, mild BR cases were treated with noninvasive standard oxygen therapy (SOT), i.e., with cold and poorly or totally non-humidified oxygen delivered by an ambient headbox or low-flow nasal cannula. Children with severe disease were intubated and treated with invasive mechanical ventilation (IMV). To improve SOT and overcome the disadvantages of IMV, new measures of noninvasive and more efficient oxygen administration have been studied. Bi-level positive air way pressure (BiPAP), continuous positive airway pressure (CPAP), and high-flow nasal cannula (HFNC) are among them. For its simplicity, good tolerability and safety, and the good results reported in clinical studies, HFNC has become increasingly popular and is now widely used. However, consistent guidelines for initiation and discontinuation of HFNC are lacking. In this narrative review, the role of HFNC to treat infants with BR is discussed. An analysis of the literature showed that, despite its widespread use, the role of HFNC in preventing respiratory failure in children with BR is not precisely defined. It is not established whether it can offer greater benefits compared to SOT and when and in which infants it can replace CPAP or BiPAP. The analysis of the results clearly indicates the need for multicenter studies and official guidelines. In the meantime, HFNC can be considered a safe and effective method to treat children with mild to moderate BR who do not respond to SOT.https://www.mdpi.com/2227-9067/8/2/66bronchiolitisCPAPBiPAPHFNCoxygen therapy |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Valentina Fainardi Lara Abelli Maria Muscarà Giovanna Pisi Nicola Principi Susanna Esposito |
spellingShingle |
Valentina Fainardi Lara Abelli Maria Muscarà Giovanna Pisi Nicola Principi Susanna Esposito Update on the Role of High-Flow Nasal Cannula in Infants with Bronchiolitis Children bronchiolitis CPAP BiPAP HFNC oxygen therapy |
author_facet |
Valentina Fainardi Lara Abelli Maria Muscarà Giovanna Pisi Nicola Principi Susanna Esposito |
author_sort |
Valentina Fainardi |
title |
Update on the Role of High-Flow Nasal Cannula in Infants with Bronchiolitis |
title_short |
Update on the Role of High-Flow Nasal Cannula in Infants with Bronchiolitis |
title_full |
Update on the Role of High-Flow Nasal Cannula in Infants with Bronchiolitis |
title_fullStr |
Update on the Role of High-Flow Nasal Cannula in Infants with Bronchiolitis |
title_full_unstemmed |
Update on the Role of High-Flow Nasal Cannula in Infants with Bronchiolitis |
title_sort |
update on the role of high-flow nasal cannula in infants with bronchiolitis |
publisher |
MDPI AG |
series |
Children |
issn |
2227-9067 |
publishDate |
2021-01-01 |
description |
Bronchiolitis (BR), a lower respiratory tract infection mainly caused by respiratory syncytial virus (RSV), can be very severe. Presently, adequate nutritional support and oxygen therapy remain the only interventions recommended to treat patients with BR. For years, mild BR cases were treated with noninvasive standard oxygen therapy (SOT), i.e., with cold and poorly or totally non-humidified oxygen delivered by an ambient headbox or low-flow nasal cannula. Children with severe disease were intubated and treated with invasive mechanical ventilation (IMV). To improve SOT and overcome the disadvantages of IMV, new measures of noninvasive and more efficient oxygen administration have been studied. Bi-level positive air way pressure (BiPAP), continuous positive airway pressure (CPAP), and high-flow nasal cannula (HFNC) are among them. For its simplicity, good tolerability and safety, and the good results reported in clinical studies, HFNC has become increasingly popular and is now widely used. However, consistent guidelines for initiation and discontinuation of HFNC are lacking. In this narrative review, the role of HFNC to treat infants with BR is discussed. An analysis of the literature showed that, despite its widespread use, the role of HFNC in preventing respiratory failure in children with BR is not precisely defined. It is not established whether it can offer greater benefits compared to SOT and when and in which infants it can replace CPAP or BiPAP. The analysis of the results clearly indicates the need for multicenter studies and official guidelines. In the meantime, HFNC can be considered a safe and effective method to treat children with mild to moderate BR who do not respond to SOT. |
topic |
bronchiolitis CPAP BiPAP HFNC oxygen therapy |
url |
https://www.mdpi.com/2227-9067/8/2/66 |
work_keys_str_mv |
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