High-flow nasal cannulae therapy decreases bronchiolitis intubation

Investigators conducted a study to determine whether the introduction of heated humidified high-flow nasal cannulae (HFNC) therapy was associated with decreased rates of intubation in infants younger than 24 months old who were admitted to a pediatric intensive care unit (PICU) with bronchiolitis. The authors performed a retrospective chart review of 57 infants who were admitted in the season before HFNC was introduced (HFNC-NA group) and 58 infants who were admitted in the season after HFNC was introduced (HFNC-A). In the season before HFNC introduction (2005-2006), most infants (58%) admitted with bronchiolitis received nasal cannulae oxygen as primary respiratory support, with a smaller number treated with other therapies. During the 2006 to 2007 season, 88% of the infants received HFNC oxygen as supportive therapy.

Only 9% of infants admitted to the PICU with bronchiolitis in the HFNC-A group required intubation, compared with 23% in the HFNC-NA group. This 68% decrease in intubation from the pre-HFNC to the post-HFNC season persisted even after controlling for age, weight, and respiratory syncytial virus (RSV) status. HFNC therapy resulted in a greater decrease in respiratory rate than other forms of respiratory support and was associated with reduced median PICU length of stay. The analysis also suggested that premature infants may benefit more from HFNC therapy than full-term infants (McKiernan C, et al. J Pediatr. 2010;156[4]:634-638).

Commentary