Effect of high-flow nasal cannula on mechanical ventilator duration in bronchiolitis patients

Objectives: High-flow nasal cannula (HFNC) therapy is a widely used non-invasive respiratory support that may decrease invasive mechanical ventilation. This study evaluated the real-world effect of HFNC on the duration of mechanical ventilation among acute bronchiolitis patients on a nationwide level. Methods: We retrospectively analyzed bronchiolitis patients (28 days–3 years old) who were admitted to tertiary hospitals for respiratory support from 2012 to 2019 using the Korean National Health Insurance database. We defined the pre-/post-HFNC period as 12 months periods before and after the initiation of HFNC in each hospital, allowing 6 months for a transition period. We compared ventilator-free days (VFDs) of two periods using a multivariable regression model. Results: In 45 hospitals, 3359 and 3565 patients of pre-HFNC and post-HFNC periods were evaluated. During the post-HFNC period, 11% of patients used HFNC, and 18.7% used mechanical ventilation. VFDs did not vary in the two periods (26.8 vs. 26.7 days, p = 0.46). In the adjusted model, VFDs did not increase in the post-HFNC period (0.08 days, 95% confidence interval: 0.09, 0.25). HFNC application rate in each hospital was not associated with an increase in mean VFDs of pre- and post-HFNC (p = 0.24). Conclusions: The application of HFNC did not increase VFDs in bronchiolitis patients in a nationwide tertiary hospital setting. This finding suggests that bronchiolitis patients may not benefit from the routine use of HFNC as rescue therapy in terms of reducing invasive procedures or utilizing resources.