Finally, a Bronchiolitis Treatment That Works

April 24, 2018

Written by Clay Smith. 

Spoon Feed
High-flow nasal cannula (HFNC) helped reduce treatment failure compared to standard nasal cannula in infants under 12 months with bronchiolitis requiring supplemental oxygen, NNT = 9.

Why does this matter?
HFNC has been used for a while for infants with bronchiolitis, but the evidence supporting its use and safety has been sparse.  This trial provides high quality evidence favoring its use.

Go with the flow
This was a RCT of 1472 infants under 12 months with bronchiolitis that required supplemental oxygen.  They were randomized to receive HFNC, 2L/kg per minute or standard nasal cannula at 2L/min.  Treatment failure was defined as: “≥3 of 4 clinical criteria: persistent tachycardia, tachypnea, hypoxemia, and medical review triggered by a hospital early-warning tool.”  In the HFNC, 12% had treatment failure.  The standard nasal cannula group had treatment failure of 23%.  NNT = 9.  Of the 167 treatment failures in the standard nasal cannula group, 102 (61%) were rescued with HFNC.  There were no adverse effects, and HFNC did not prolong hospital stay.  They used the Optiflow system with the use of an age-appropriate Optiflow Junior cannula and the Airvo 2 high-flow system.

Source
A Randomized Trial of High-Flow Oxygen Therapy in Infants with Bronchiolitis.  N Engl J Med. 2018 Mar 22;378(12):1121-1131. doi: 10.1056/NEJMoa1714855.

Peer reviewed by Thomas Davis.