Early use of heated and humidified high-flow nasal cannula (HFNC) therapy in pediatric bronchiolitis: A prospective observational study

Abstract

Background/Objectives: Bronchiolitis is a leading cause of pediatric hospitalization, particularly in infants, where conventional low-flow oxygen therapy may be insufficient in managing moderate to severe respiratory distress. High-flow nasal cannula (HFNC) therapy delivers heated and humidified oxygen and has shown promise in critical care settings. This study evaluates the impact of early HFNC (AIRVO) initiation on general pediatric wards in reducing the need for Pediatric Intensive Care Unit (PICU) admissions and shortening hospital stays. In this prospective observational study, 50 children aged 1 month to 12 years with moderate to severe bronchiolitis were managed with HFNC therapy via the AIRVO system on the pediatric floor at a tertiary care center. Outcomes were compared with a matched historical control group of 50 patients treated with standard low-flow oxygen therapy. Primary outcomes included PICU admission rate and hospital length of stay. Statistical analysis was performed using chi-square and t-tests, with significance set at p < 0.05. The HFNC group demonstrated a significantly lower PICU admission rate (10% vs. 40%; p < 0.01) and a shorter mean hospital stay (3.7 vs. 5.2 days; p < 0.01). Additionally, time to achieve oxygen saturation >94% was faster in the HFNC group (12 vs. 18 hours). No adverse events were reported in either group. Early use of HFNC therapy with the AIRVO system on pediatric wards is a safe and effective strategy for managing moderate to severe bronchiolitis. It significantly reduces the need for PICU transfer and facilitates earlier recovery and discharge, offering a valuable alternative to traditional escalation pathways.