Is high-flow nasal cannula therapy feasible for managing bronchiolitis in children in the emergency department?
Amy Dallison's literature review examines the potential benefits of using high-flow nasal cannula therapy for bronchiolitis in children
For her dissertation, Amy Dallison carried out a literature review of the potential benefits of using high-flow nasal cannula therapy for bronchiolitis in children in hospital emergency departments
Bronchiolitis is a common condition affecting infants. Emergency department (ED) management of the condition for children in England has involved oxygen therapy through use of a standard oxygen mask, which children do not always tolerate. Recent research has looked at high-flow nasal cannula therapy as an alternative way to manage bronchiolitis in the ED.
To determine whether high-flow nasal cannula therapy is a suitable and effective approach in EDs for infants with bronchiolitis.
Databases that were searched included CINAHL, MEDLINE, Embase and the Cochrane Library. Citation and handsearching were also carried out. Studies were selected if the majority of participants were under two years old with bronchiolitis as their main condition and high-flow nasal cannula therapy was used. Articles were excluded if there was no data from an ED or equivalent setting and if they primarily included life-threatening or severe conditions. Ten articles were used in the review.
Common themes were identified from the literature. Primary outcomes that emerged included the physiological impact of commencing high-flow nasal cannula therapy in the ED. Overall, the studies suggested that beginning the therapy improved children’s vital signs significantly more in the first hour of treatment compared with standard therapy and led to a reduced number of intubations.
Further secondary outcome measures included the cost-effectiveness of beginning high-flow nasal cannula therapy in an ED, the safety of the therapy in an ED, tolerability and whether the therapy helps to identify future care needs.
The studies suggest that early use of the therapy could help to ascertain whether a child needs to be in critical care. Findings on its cost-effectiveness varied. All the studies suggested it was a safe and tolerable method of delivering oxygen.
Implications for practice
Findings from the literature review along with guidelines and evidence have been considered in recommending how the results could be applied in practice.
- Looking at whether guidelines need to be changed.
- What training is required.
- Cost considerations.
- Criteria for beginning high-flow nasal cannula therapy.
While the results of the ten studies are consistent, suggesting high-flow nasal cannula therapy is an effective method to use, there is a lack of good evidence, particularly in the form of multi-centre randomised controlled trials and studies based in England, which was part of the original objective of the dissertation. More primary studies should be conducted on a larger scale before the results of this review are applied in practice.
- Bressan S, Balzani M, Krauss B et al (2013) High-flow nasal cannula oxygen for bronchiolitis in a pediatric ward: a pilot study
- Davison M, Watson M, Wockner L et al (2017) Paediatric high-flow nasal cannula therapy in children with bronchiolitis: A retrospective safety and efficacy study in a non-tertiary environment
- Franklin D, Babl F, Schlapbach L et al (2018) A randomized trial of high-flow oxygen therapy in infants with bronchiolitis
- Goh C, Kirby L, Schell D et al (2017) Humidified high-flow nasal cannula oxygen in bronchiolitis reduces need for invasive ventilation but not intensive care admission
- Kepreotes E, Whitehead B, Attia J et al (2017) High-flow warm humidified oxygen versus standard low-flow nasal cannula for moderate bronchiolitis (HFWHO RCT): ab open, phase 4, randomised controlled trial
- Long E, Babl F, Duke T (2016) Is there a role for humidified heated high-flow nasal cannula therapy in paediatric emergency departments?
- Mayfield S, Bogossian F, O’Malley L et al (2014) High-flow nasal cannula oxygen therapy for infants with bronchiolitis: pilot study
- Mikalsen I, Davis P, Øymar K (2016) High flow nasal cannula in children: a literature review
- Milani G, Plebani A, Arturi E et al (2016) Using a high-flow nasal cannula provided superior to low-flow oxygen delivery in moderate to severe bronchiolitis
- Wing R, James C, Maranda L et al (2012) Use of high-flow nasal cannula support in the emergency department reduces the need for intubation in pediatric acute respiratory insufficiency
About the author
Amy Dallison is a staff nurse in the paediatric intensive care unit at Leeds Children’s Hospital. Her dissertation supervisor was Michelle Green of the School of Healthcare, University of Leeds. This article was written on behalf of the RCN's Research in Child Health (RiCH) community