High-Flow Nasal Cannula Versus Continuous Positive Airway Pressure in Infants with Bronchiolitis: A Systematic Review

Abstract

Background: Bronchiolitis is a common lower respiratory tract infection in infants and a major cause of hospital admissions. Non-invasive respiratory support is frequently required, with high-flow nasal cannula (HFNC) and continuous positive airway pressure (CPAP) being the most commonly used modalities. However, their relative effectiveness remains a topic of ongoing debate. Methods: This systematic review was conducted in accordance with PRISMA guidelines. A comprehensive search of PubMed, Embase, Scopus, Web of Science, and the Cochrane Library was performed to identify studies comparing HFNC and CPAP in infants with bronchiolitis. Randomized controlled trials and comparative observational studies were included. The primary outcomes assessed were treatment failure, escalation of respiratory support, and need for invasive mechanical ventilation. Secondary outcomes included pediatric intensive care unit (PICU) admission, duration of hospitalization, adverse events, and mortality. Results: Seven studies, including six randomized controlled trials and one observational study, were included in the analysis. Four studies specifically focused on infants, while three included broader pediatric populations. Several studies reported lower treatment failure rates with CPAP, particularly in more severe cases. However, no consistent differences were observed between HFNC and CPAP in terms of invasive mechanical ventilation or length of hospital stay. HFNC was generally associated with better tolerance and fewer minor complications related to the respiratory interface. Variability in study design and outcome definitions contributed to heterogeneity across the included studies. Conclusions: Both HFNC and CPAP are effective non-invasive respiratory support options for infants with bronchiolitis. CPAP may offer advantages in reducing treatment failure in severe disease, whereas HFNC is associated with improved comfort and ease of application. HFNC may be used as an initial strategy, with escalation to CPAP when required. Further high-quality studies are needed to clarify optimal management approaches.