Increase of high flow nasal cannulas use after the pandemic in bronchiolitis: a more severe disease or a changed physician’s attitude?

Abstract

In the 2020–2021 winter season, COVID related measures reduced the incidence of bronchiolitis to a tenth. The aim of this study was to describe the chat-up of hospitalization for bronchiolitis during the latter winter. The primary outcome was the prevalence of high flow nasal cannula (HFNC) that spread over the pre-pandemic decade. We performed a retrospective study at four Italian hospitals collecting data on infants (<1 year) hospitalized for bronchiolitis from September 1st to March 31st. During the last winter, 197 out of 300 patients (66%) received HFNC treatment; 5 patients out of 22 (23%) during the pandemic winter(p<0.001); 99 out of 259 (38%) and 102 out of 295 (35%) in the latter two pre-pandemic winters (p<0.001). Non-invasive ventilation and continuous positive airway pressure use similarly increased: 68 patients (23%) in the last winter vs 2 (9%) in the pandemic winter; 42 (16%) and 36 (12%) in the latter two pre-pandemic winters (p=0.003). Intensive care admission increased to 29% from 22-15% of the pre-pandemic period. HFNC use was extended this winter to 2.8± 2.7 days vs 1.7± 2.7 and 1.3 ± 2.2 in the two pre-pandemic SOPswinters respectively (p<0.001). On the opposite, all the other severity indexes such as intubation need, in-hospital length of stay or ICU length of stay did not differ. Therefore a more severe disease course behind the respiratory support choice seem unlikely and we rather recognize a change in paediatrician attitude to less tolerate respiratory distress with an easier step-up in respiratory support leading to an overtreatment starting with a non-evidence-based and maybe non wisely choice of HFNC candidates