Tortosa Fernando, Izcovich Ariel, Carrasco Gabriela, Varone Gabriela, Haluska Pedro, Sanguine Verónica
Comité de Evaluación de Biotecnologías, Ministerio de Salud, Río Negro, Argentina; Red Argentina Pública de Evaluación de Tecnologías Sanitarias, Neuquén, Argentina; Departamento de Docencia e Investigación, Hospital Zonal Ramón Carrillo de Bariloche, Río Negro, Argentina. Dirección: Moreno 601, San Carlos de Bariloche, Río Negro, Argentina. Email:
Servicio de Clínica Médica, Hospital Alemán, Buenos Aires, Argentina. ORCID: 0000-0001-9053-4396.
Medwave. 2021 May 12;21(4):e8190. doi: 10.5867/medwave.2021.04.8190.
Oxygen therapy through a high-flow nasal cannula is thought to improve the work of breathing and the comfort of patients with acute bronchiolitis. It is widely used in hospital wards and critical care of pediatric patients. However, there is uncertainty on the magnitude of the effect on critical and important outcomes in these patients.
The objective of this review is to evaluate the available evidence on the use of oxygen administered through high-flow cannula versus low-flow oxygen for the treatment of acute bronchiolitis in children under two years of age.
We carried out a systematic review and a meta-analysis following the PRISMA standards for reporting. The search was carried out in electronic databases by two researchers independently. The evidence was summarized using the GRADE methodology.
Six randomized and non-randomized clinical trials were included, including 1867 individuals younger than 24 months of age with acute bronchiolitis in pediatric emergency, hospitalization, and intensive care services. Mortality was not reported in the included studies. Treatment failure occurred in 108/933 in the high flow group and 233/934 in the low flow group (relative risk: 0.46; 95% confidence interval: 0.35 to 0.62), which shows 11.7% less treatment failure (95% confidence interval between 7.9% and 14.5% less) in the high flow group with a number needed to treat of 7.5 (95% confidence interval 6 to 10) with moderate certainty in the evidence.
The use of humidified and heated oxygen with high flow compared to oxygen at low flow is probably associated with decreased treatment failure in children younger than two years with acute bronchiolitis. There is uncertainty about the effect on hospitalization days and clinical progression.
经高流量鼻导管进行氧疗被认为可改善急性细支气管炎患者的呼吸功能及舒适度。它在儿科病房及危重症护理中广泛应用。然而，对于这些患者关键和重要结局的影响程度尚存在不确定性。
本综述的目的是评估关于使用高流量导管输氧与低流量输氧治疗两岁以下儿童急性细支气管炎的现有证据。
我们按照PRISMA报告标准进行了系统综述和荟萃分析。由两名研究人员独立在电子数据库中进行检索。采用GRADE方法对证据进行总结。
纳入了六项随机和非随机临床试验，包括1867名年龄小于24个月、在儿科急诊、住院及重症监护服务中患有急性细支气管炎的个体。纳入研究中未报告死亡率。高流量组933例中有108例治疗失败，低流量组934例中有233例治疗失败（相对风险：0.46；95%置信区间：0.35至0.62），这表明高流量组治疗失败率降低了11.7%（95%置信区间为降低7.9%至14.5%），需治疗人数为7.5（95%置信区间6至10），证据具有中等确定性。
与低流量输氧相比，对两岁以下急性细支气管炎患儿使用温热湿化高流量输氧可能与治疗失败率降低相关。对住院天数和临床进展的影响尚不确定。
