Comparison of heated humidified high-flow nasal cannula flow rates (1-L·kg·min vs 2-L·kg·min ) in the management of acute bronchiolitis.

OBJECTIVE

We aimed to compare the heated humidified high-flow nasal cannula (HHHFNC) flow rate of 1-L·kg·min (1 L) with 2-L·kg·min (2 L) in patients with severe bronchiolitis presenting to the pediatric emergency department.

STUDY DESIGN

We performed a study in which all patients were allocated to receive these two flow rates. The primary outcome was admitted as treatment failure, which was defined as a clinical escalation in respiratory status. Secondary outcomes covered a decrease of respiratory rate (RR), heart rate (HR), the clinical respiratory score (CRS), rise of peripheral capillary oxygen saturation (SpO ), and rates of weaning, intubation, and intensive care unit (ICU) admission.

RESULTS

One hundred and sixty-eight cases (88 received the 1-L flow rate and 80, the 2-L flow rate) were included in the analyses. Treatment failure was 11.4% (10 of 88) in the 1-L group, and 10% (8 of 80) in the 2-L group (P = .775). Significant variation in the intubation rate or the ICU admission rate was not determined. At the 2nd hour, the rate of weaning (53.4% vs 35%; P = .017), the falling down of the CRS (-2.1 vs -1.5; P < .001), RR (-15.2 vs -11.8; P < .001), and HR (- 24.8 vs - 21.2; P < .001), and the increase of SpO (4.8 vs 3.6; P < .001) were significantly more evident in the 1-L group.

CONCLUSION

HHHFNC with the 1-L·kg·min flow rate, which provides a more frequent earlier effect, reached therapy success as high as the 2-L·kg·min flow rate in patients with severe acute bronchiolitis.