Written by Kimiko Dunbar
Spoon Feed
This meta-analysis revealed that when compared to conventional oxygen therapy and noninvasive ventilation, high-flow nasal cannula significantly reduced intubation rates and ICU stays without increasing adverse events.
HFNC––is the juice worth the squeeze?
High-flow nasal cannula (HFNC) therapy is a simple way to deliver enhanced respiratory support while allowing for increasing levels of FiO2 and inspiratory support. Lauded for being less invasive than CPAP or BiPAP and having decreased rates of treatment failure in bronchiolitis, it’s become an attractive option for pediatric respiratory disease. That said, recent literature has revealed concerns about high-flow overuse, resulting in quality improvement initiatives to reduce high-flow use when not necessary.
This meta-analysis examined whether early use of HFNC improves outcomes in pediatric respiratory distress. Ten studies (n=7,762) were included (5 RCTs, 5 observational studies) comparing HFNC to conventional oxygen therapy and noninvasive ventilation (NIV). HFNC significantly reduced intubation rates (OR=0.55, p=0.01) and ICU stay duration versus NIV (MD=−2.76 days, p=0.02), with no increase in adverse events. Limitations include heterogeneity (large age range of patients, flow rates of 5-50L, variation in clinical presentation of the populations and disease severity), inclusion of observational data, and lack of long-term follow-up. HFNC appears beneficial, though judicious use and guideline development are warranted.
How does this change my practice?
The degree of heterogeneity of the studies included in this meta-analysis gives me pause. HFNC is an intervention used for a variety of acute conditions, and initiation is quite variable. Having worked at multiple institutions with differing policies on where HFNC can be initiated, I’ve seen the criteria for initiation vary widely, especially as compared to NIV. Further, the meta-analysis includes a huge range of flow rates (5-50L) which, depending on a patient’s weight, deliver massively different levels of support. Overall, I think we need more robust data comparing more homogeneous disease states before I’ll change my practice.
Source
Outcomes of early high-flow nasal cannula (HFNC) use in pediatric respiratory distress in acute settings: a meta-analysis. Eur J Pediatr. 2025 Jun 5;184(7):393. doi: 10.1007/s00431-025-06219-0. PMID: 40467999
