Predictive features of high flow oxygen supplementation failure in infants with severe acute bronchiolitis


The aim of the study is to describe the clinical course of infants hospitalized with bronchiolitis who underwent high-flow oxygen supplementation via nasal cannula (HFNC) and investigate HFNC failure. We extracted clinical charts of the 130 infants who required oxygen delivered by HFNC and clinical, epidemiological, laboratory, and radiological data were analyzed, out of 824 infants admitted for bronchiolitis over seven epidemic seasons. We ran a multivariate logistic regression analysis (adjusted for age and sex) in order to determine factors associated with HFNC failure. HFNC therapy failed only in 11 (8.5%) out of 130 infants. Infants with HFNC failure were younger with a lower admission weight, and they received more frequently low-flow oxygen before HFNC than patients who underwent HFNC only. Clinical severity score at admission and laboratory findings were similar in the two groups. They showed more frequently complete upper lobe consolidations on chest X-ray (CXR) than infants exclusively supported by HFNC. Moreover, respiratory syncytial virus was more frequently detected in patients with HFNC failure. The presence of complete lobe consolidation was the only significant factor associated with HFNC failure. An early identification of complete lobe consolidation in severe infants with bronchiolitis may guide a personalized management.


What is already known about this topic? HFNC is a safe and useful method of non-invasive respiratory support. However, several questions concerning HFNC clinical practice remain unanswered. What does this article add to our knowledge? Patients who experienced a failure of HFNC showed more frequently a complete lobe consolidation on CXR than infants in whom HFNC allowed to overcome respiratory distress. How does this study impact current management guidelines?An early identification of consolidation with adequate follow-up and proper therapeutic strategies may further reduce the number of children requiring more intensive care. Finally, a CXR could be mandatory on a severe disease respiratory distress.


Received: Feb 3, 2023
Accepted: Mar 20 2023
Published: June 1, 2023

Table of Contents: Vol. 1, n. 2, June 2023

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