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J Paediatr Child Health. 2019 Jul;55(7):746-752. doi: 10.1111/jpc.14496.

'Rational use of high-flow therapy in infants with bronchiolitis. What do the latest trials tell us?' A Paediatric Research in Emergency Departments International Collaborative perspective.

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Emergency Department, Perth Children's Hospital, Perth, Western Australia, Australia.
School of Nursing, Midwifery and Paramedicine, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia.
Emergency Department, Monash Medical Centre, Melbourne, Victoria, Australia.
School of Clinical Sciences, Monash University, Melbourne, Victoria, Australia.
Emergency Department, Royal Children's Hospital, Melbourne, Victoria, Australia.
Emergency Research, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.
Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.
Division of Paediatric and Emergency Medicine, School of Medicine, University of Western Australia, Perth, Western Australia, Australia.
Paediatric Emergency Medicine Centre of Research Excellence, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.
Children's Emergency Department, Starship Children's Hospital, Auckland, New Zealand.
Department of Surgery, Child and Youth Health, The University of Auckland, Auckland, New Zealand.
Department of Paediatrics, Child and Youth Health, The University of Auckland, Auckland, New Zealand.


Bronchiolitis is the most common reason for infants to be hospitalised. Over the past decade, the use of high-flow nasal cannulae (HFNC) therapy has increased markedly and it is now utilised not only in the intensive care unit setting but in general paediatric wards and emergency departments. The aim of this systematic review was to summarise and critique the current evidence-base for the use of HFNC in infants with bronchiolitis. We searched Ovid Medline, OvidEmbase, PubMed, Cinahl, Cochrane Library, Cochrane Database of Systematic Reviews and Cochrane Central Register of Controlled Trials for systematic reviews and randomised controlled trials of HFNC therapy in infants with bronchiolitis from 1 January 2000 to 27 June 2018. We identified four randomised controlled trials (n = 1891) of HFNC in infants with bronchiolitis: three of these studies involved infants treated in emergency departments and inpatient paediatric wards in Spain, Australia and New Zealand, and one study involved infants treated in paediatric intensive care units in France. The findings of this review suggest that HFNC should be used as a rescue treatment for hypoxaemic infants who have not responded to standard sub nasal oxygen therapy. The use of HFNC for work of breathing in the absence of hypoxaemia, and severe disease, is not currently supported by the evidence, and should only be considered in the context of an appropriate research trial.


bronchiolitis; high-flow; infant


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