High-flow nasal cannula versus continuous positive airway pressure for noninvasive respiratory support in children with bronchiolitis: a meta-analysis of randomized controlled trials.

BACKGROUND: High-flow nasal cannula (HFNC) and continuous positive airway pressure (CPAP) are increasingly used for noninvasive respiratory support in children with bronchiolitis, but their comparative efficacy and safety remain uncertain. This meta-analysis aimed to compare HFNC and CPAP in children with bronchiolitis based on evidence from randomized controlled trials (RCTs). METHODS: PubMed, Cochrane Library, Embase, Web of Science, Wanfang, and CNKI were systematically searched for RCTs comparing HFNC and CPAP in children with bronchiolitis. The primary outcome was treatment failure. Secondary outcomes included invasive mechanical ventilation (MV) and adverse events (AEs). Risk ratios (RRs) with 95% confidence intervals (CIs) were pooled using a random-effects model. RESULTS: Ten RCTs involving 965 children were included. Overall, HFNC was not associated with a significantly different risk of treatment failure compared with CPAP (RR: 0.80, 95% CI: 0.50-1.29, p = 0.37; moderate-certainty evidence). Subgroup analyses suggested that HFNC was associated with a lower risk of treatment failure in children treated in pediatric wards, in studies with mean age >3 months, and in those with mean body weight >6 kg. The rate of invasive MV was also not significantly different between groups (RR: 0.88, 95% CI: 0.61-1.29, p = 0.51; low-certainty evidence). Howevnker, HFNC was associated with a significantly lower incidence of AEs compared with CPAP (RR: 0.35, 95% CI: 0.22-0.57, p < 0.001; low-certainty evidence). CONCLUSIONS: HFNC and CPAP appear to provide comparable efficacy for noninvasive respiratory support in children with bronchiolitis, while HFNC may reduce device-related AEs. Subgroup and meta-regression analyses further suggested that the relative efficacy of HFNC may be influenced by patient age and body weight, with more favorable effects observed in older and heavier children. SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/PROSPERO/view/CRD420261404713, PROSPERO CRD420261404713.