WIP 69 - Effectiveness of weaning strategies for High-Flow Nasal Cannula (HFNC) among children with bronchiolitis: A systematic review and meta-analysis

Celia Kwan, McMaster University Michael G. DeGroote School of Medicine, Hamilton, ON, Canada; Shamini Selvakumar, McMaster University Michael G. DeGroote School of Medicine, Oakville, ON, Canada; Shadi Sadeghian, The Hospital for Sick Children, Toronto, ON, Canada; Gita Wahi, McMaster University, Hamilton, ON, Canada

Background: Heated humidified high-flow nasal cannula (HFNC) is increasingly used to provide respiratory support for children with bronchiolitis. However, variability exists in how HFNC is implemented. Some providers have highlighted that patients may be on HFNC longer than needed. There is conflicting evidence on whether initiating a weaning protocol for HFNC reduces the length of stay (LOS) or time a patient requires HFNC.

Objective: Given the variability in weaning protocols of HFNC and the need to establish consensus, this systematic review aims to summarize the evidence regarding the effectiveness of weaning strategies of HFNC in the management of bronchiolitis in children less than 24 months.

Design/Methods: This will be a systematic review of randomized controlled trials and quasi-experiment study designs. Literature searches will be performed using Medline, EMBASE, Cochrane CENTRAL, and CINAHL. Two investigators will independently review study titles and abstracts. Full-text articles will be retrieved for all studies meeting inclusion criteria. For final article inclusion, two investigators will independently review all full-text articles. Disagreements will be resolved through discussion with a third investigator. In duplicate, two investigators will independently extract information of included studies using a standardized form. The primary outcome will be change in LOS. Secondary outcomes will be clinical improvement defined by a respiratory score, change in hospital readmission rates, change in PICU readmission rates, length of time on HFNC, and change in rates of escalation in respiratory support. If a meta-analysis is appropriate, a random-effects or fixed-effect model will be conducted as appropriate. To explore heterogeneity, statistical testing including chi-squared and I2 will be employed. The Grading of Recommendations Assessments, Developments and Evaluation will be used to report the quality of evidence and strength of recommendations.
Timeline: title/abstract screening, and full text review are complete. Data extraction/analysis will be done by February 2025.