Outcomes of early high-flow nasal cannula (HFNC) use in pediatric respiratory distress in acute settings: a meta-analysis.

With the increasing incidence of pneumonia and acute respiratory distress in pediatric populations, effective oxygen delivery techniques are crucial for improving clinical outcomes. However, a debate exists across current studies on the use of high-flow nasal cannula (HFNC), and whether its benefits outweight the overutilization in a hospital setting. This systematic review and meta-analysis evaluates HFNC therapy in comparison to conventional oxygen therapy and noninvasive ventilation (NIV). A literature search was conducted to identify studies comparing HFNC to other oxygen delivery modalities in pediatric populations with acute respiratory distress were included. Outcomes include intubation rates, hospital and ICU stays, adverse events, and mortality. Statistical analysis was performed using RevMan software. A total of 10 studies comprising 7,762 patients were identified for quantitative analysis. HFNC significantly reduced intubation rates compared to conventional oxygen therapy (OR = 0.55, 95% CI: 0.34-0.89, p = 0.01). It also reduced ICU length of stay compared to NIV (MD = -2.76, 95% CI: -4.98 to -0.53, p = 0.02) and was associated with a lower mortality risk compared to NIV (OR = 0.62, 95% CI: 0.44-0.86, p = 0.005). However, HFNC did not show significant differences in success rates or adverse events when compared to either oxygen therapy or NIV. Conclusion: HFNC demonstrates substantial benefits in reducing intubation rates and ICU stays compared to conventional oxygen therapy and NIV. While HFNC appears promising for pediatric respiratory distress management, increased ICU admissions and longer hospital stays remain areas for further research. What is Known: • Acute respiratory distress syndrome (ARDS) is a leading cause of morbidity and mortality in pediatric populations globally. High-flow nasal cannula (HFNC) therapy is a non-invasive oxygen delivery method that reduces inspiratory resistance and provides higher oxygen flow. • HFNC has been associated with reduced intubation rates compared to conventional oxygen therapy in past studies. • Non-invasive ventilation (NIV) and conventional oxygen therapy are established methods for respiratory support but present with limitations such as higher intubation rates and risks of complications. What is New: • HFNC significantly reduces intubation rates compared to conventional oxygen therapy (OR = 0.55, p = 0.01) and is associated with shorter ICU stays compared to NIV (MD = -2.76 days, p = 0.02). • However, HFNC does not show significant advantages in success rates or adverse events compared to other oxygen delivery methods. HFNC also resulted in longer hospital stays compared to conventional oxygen therapy (MD = 0.38 days, p = 0.01). The study highlights the need for judicious use of HFNC and the establishment of standardized clinical guidelines to optimize its use.