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High flow nasal cannula and continuous positive airway pressure therapy in treatment of viral bronchiolitis: a randomized clinical trial


Continuous positive airway pressure (CPAP) has been used in infants with bronchiolitis for decades. Recently, high flow nasal cannula (HFNC) therapy was introduced. We conducted a trial of 50 children with bronchiolitis who were randomized to treatment with CPAP or HFNC. Objectives were to compare the development in respiratory rate, pCO2, and Modified Woods Clinical Asthma Score (M-WCAS) in young children with bronchiolitis, treated with CPAP or HFNC. Secondarily, to compare Neonatal Infant Pain Score (NIPS), treatment duration, treatment failure, and hospitalization length. Median age at inclusion was 2.8 (CPAP group) vs 2.1 months (HFNC group). Mean baseline pCO2 was 6.7 in both groups and mean respiratory rate was 60 vs 56 in the CPAP and HFNC group respectively. No differences were observed in development of respiratory rate, pCO2, or M-WCAS. NIPS was higher in the CPAP group. Treatment failure was scarce in both groups. No significant differences in treatment duration or length of hospitalization were observed.

Conclusion: In infants and young children with bronchiolitis, HFNC may be an effective and pleasant alternative to CPAP. Larger multicenter studies are needed to further explore differences in treatment failure and treatment duration.

Trial registration: www.clinicaltrial.gov. id NCT02618213, registration date December 1, 2015.

What is Known:
CPAP has been used for many years for respiratory support in infant bronchiolitis. The method requires special staff skills and may be stressful to the child.
• HFNC has been introduced as a newer tool.
What is New:
In infants with bronchiolitis, HFNC and CPAP were comparable in decreasing respiratory rate, pCO2, and need for oxygen supply.
• Pain score during therapy was lower in the HFNC group.

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Fig. 1



Respiratory syncytial virus


Continuous positive airway pressure


High flow oxygenation therapy


Respiratory rate


Modified Woods Clinical Asthma Score


Neonatal Infant Pain Score


Face Leg Activity Cry and Consolability


Pediatric intensive care unit


Fraction of inhaled oxygen


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We thank OPEN, University of Southern Denmark, for statistical support.

Author information

Signe Vahlkvist, Thomas Houmann Petersen, and Poul-Erik Kofoed contributed to the study conception and design. Data collection was performed by all authors. Statistical analyses were performed by Signe Vahlkvist with support from OPEN, University of Southern Denmark. The first draft of the manuscript was written by Signe Vahlkvist, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Correspondence to Signe Vahlkvist.

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The authors declare that they have no conflicts of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee (The Regional Committee on Health Research Ethics for Southern Denmark ref. nr S-20150007) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual parents/legal guardians of participants included in the study.

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Vahlkvist, S., Jürgensen, L., la Cour, A. et al. High flow nasal cannula and continuous positive airway pressure therapy in treatment of viral bronchiolitis: a randomized clinical trial. Eur J Pediatr 179, 513–518 (2020). https://doi.org/10.1007/s00431-019-03533-2

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  • Bronchiolitis
  • CPAP
  • HFNC
  • Respiratory syncytial virus
  • Infants