HFNC do not change intubation rates in bronchiolitis: a retrospective multicenter study

High-flow nasal cannula (HFNC) therapy has emerged as an effective intervention for reducing the need for intubation when compared to low-flow oxygen therapy (LFO2) in infants with bronchiolitis. However, recent data showed similar failure rates compared to LFO2. We investigated the use of non-invasive respiratory support (NRS) among hospitalized infants under 12 months with bronchiolitis in Trieste (Italy) and Belgrade (Serbia) between January 2016 and February 2023. 709 (151 Trieste and 558 Belgrade) received at least one NRS during the study period. The two cohorts did not differ in terms of age, gender, comorbidities and vital parameters at presentation. LFO2 was the initial choice in 80.1% of cases (25.2% Trieste vs 95% Belgrade, p<0.001), while HFNC was mostly used in Trieste (70.9%) compared to Belgrade (4.1%) (p<0.001). Continuous positive airway pressure (CPAP) and bilevel positive airway pressure (BiPAP) were the initial NRS for 9 and 2/709 infants. HFNC and CPAP/BiPAP use as the second NRS did not significantly differ between centres. Initial NRS failed in 86/709 infants, irrespective of the type of support (37.1% Trieste vs 5.4% Belgrade). LFO2 failed in 8.8% of cases (50/568), with a difference between the two centers (68.4% vs 4.5%, p<0.001). HFNC failed in 25.4% of cases (33/130). The overall intubation rate was low (8/151 Trieste vs 16/558 Belgrade, p=0.143), with 3 deaths recorded among Serbian patients, all of whom had underlying comorbidities. Our findings suggest that LFO2 may be associated with a lower failure rate than HFNC within similar patient cohorts. Despite variations in NRS use between centers, both cohorts exhibited comparable outcomes in terms of intubation rates.