Comparative Efficacy of Continuous Positive Airway Pressure Versus High-Flow Nasal Cannula Therapy in Children With Acute Bronchiolitis: A Systematic Review and Meta-Analysis

TL;DR

This study compares two breathing treatments for children with acute bronchiolitis and finds they are similarly effective, with potential advantages for one in certain settings.

Contribution

The study provides a meta-analysis comparing CPAP and HFNC in children with acute bronchiolitis, highlighting their comparable efficacy and practical considerations.

Findings

CPAP and HFNC showed no significant difference in the need for invasive mechanical ventilation.

HFNC had a higher, though not statistically significant, risk of treatment failure compared to CPAP.

Hospital stay duration was similar between CPAP and HFNC treatments.

Abstract

This systematic review and meta-analysis compared the efficacy of continuous positive airway pressure (CPAP) and high-flow nasal cannula (HFNC) therapy in children with acute bronchiolitis. A comprehensive literature search across multiple electronic databases identified six randomized controlled trials for inclusion. The primary outcomes assessed were treatment failure, the need for invasive mechanical ventilation, and length of hospital stay. Pooled analysis revealed no significant difference between CPAP and HFNC in the risk of requiring invasive mechanical ventilation (RR 0.94, 95% CI: 0.60-1.46) with minimal heterogeneity across studies. Treatment failure was higher in the HFNC group than in CPAP, but this difference was not statistically significant (RR 1.20, 95% CI: 0.63-2.27), though heterogeneity was substantial (I²=70%). Sensitivity analysis after removing one study showed a significantly higher risk of treatment failure with HFNC (RR 1.67, 95% CI: 1.07-2.61) with reduced heterogeneity. Length of hospital stay was comparable between both interventions (MD 0.57, 95% CI: -0.16-1.31). Both respiratory support strategies effectively reduce respiratory effort in moderate to severe bronchiolitis through different mechanisms, such as CPAP, which provides consistent positive end-expiratory pressure, and HFNC through enhanced minute ventilation and nasopharyngeal dead space reduction. Despite some limitations, including small sample sizes and inability to conduct subgroup analyses due to lack of individual patient data, this meta-analysis suggests HFNC may serve as a viable alternative to CPAP, particularly in resource-limited settings, showing comparable outcomes for critical endpoints while potentially offering practical advantages in administration and patient comfort.

Figures