High-Flow Oxygen Therapy vs. Continuous Positive Airway Pressure in Hospitalised Bronchiolitis: A Meta-Analysis

Aim: To compare high-flow oxygen therapy (HFOT) with continuous positive airway pressure (CPAP) in children with bronchiolitis aged < 24 months, using treatment failure, length of stay (LOS) in the paediatric intensive care unit (PICU), and adverse events as outcomes. Methods: Systematic literature search was conducted using PubMed and Scopus until March 13, 2024. Data from prospective and retrospective studies comparing HFOT to CPAP were incorporated in the random-effects meta-analysis model. The results for treatment failure were presented as risk ratios (RRs) with 95% confidence intervals (95% CIs), and those for LOS in the PICU as mean differences (MD) with 95% CIs. Results: Eight studies fulfilled the inclusion criteria, and one study was found by manual search. Treatment failure was less often associated with CPAP than with HFOT (RR: 0.65; 95% CI: 0.51–0.81). Instead, LOS in the PICU did not differ (standardised MD: −0.10; 95% CI: −0.27 to 0.06). Adverse events were minor being associated more often with CPAP. Conclusion: Both HFOT and CPAP were safe for treating bronchiolitis, but CPAP showed a lower risk of treatment failure. Our results can be generalized to those treated in the PICU.