Application of the 2023 Italian guidelines for respiratory support management in acute viral bronchiolitis: a retrospective study

Abstract

Objective: To evaluate the impact of the 2023 Italian guidelines on respiratory support management for acute viral bronchiolitis by comparing the use of low-flow oxygen (LFO) and high-flow nasal cannula (HFNC) therapies during the 2022–2023 and 2023–2024 epidemic seasons. Design: A retrospective, single-centre observational study. Setting: The paediatric emergency department of Policlinico Umberto I, Rome, Italy. Patients: A total of 202 infants (<12 months) with hypoxaemia due to acute viral bronchiolitis were hospitalised during the study periods. Eight patients were excluded due to chronic conditions or missing data. Interventions: The study compared LFO as a first-line therapy and HFNC as a second-line option in cases of LFO failure, before (2022–2023) and after (2023–2024) the guideline update. Main outcome measures: Rates of LFO and HFNC use, treatment failure, intubation, intensive care unit (ICU) admission, length of hospitalisation and oxygen therapy duration. Results: HFNC use as a first-line therapy decreased from 43.5% to 5.5%, while LFO use increased from 56.5% to 94.5%. LFO failure rates dropped significantly from 50% to 23%. No significant changes were observed in HFNC failure rates (12.5% vs 16.7%), ICU admissions or intubation rates. The average hospital stay decreased from 5.1±2.3 to 4.1±2.0 days, with a concomitant reduction in oxygen therapy duration. Conclusions: The 2023 Italian guidelines significantly reduced inappropriate HFNC use and hospital stay length without compromising patient outcomes. These findings support the step-up approach, emphasising LFO as the preferred first-line therapy.