High-flow nasal cannula in Pediatrics, common pediatric respiratory diseases and potential uses: a scoping systematic review

Purpose: The growing use of high-flow nasal cannula (HFNC) in pediatric inpatient settings raises questions about its efficacy, safety, and cost-effectiveness compared to other non-invasive ventilation (NIV) systems. This scoping review synthesizes available evidence on the indications, benefits, and risks of HFNC in the pediatric population to identify its primary applications and key research priorities. Methods: We conducted a scoping systematic review by retrieving articles from PubMed, Scopus, and Google Scholar databases, adhering to PRISMA-ScR guidelines. Studies published since 2017 were included, with a focus on the application of HFNC in bronchiolitis, asthma, pneumonia, and obstructive sleep apnea (OSA). Key parameters analyzed included dosing, clinical indications, and efficacy outcomes. Results: Among the 44 selected articles, the evidence demonstrated mixed results across different pathologies. The strongest supporting evidence was consistently observed in the treatment of bronchiolitis and its effective use as a rescue or intermediate therapy in critical conditions. Conclusions: The absence of standardized protocols and variability in dosing limit the widespread application of HFNC. While initial costs are reportedly high, its use may reduce the need for other therapeutic resources and pediatric intensive care unit (PICU) stays, offering long-term economic benefits. There is an urgent need for rigorously designed controlled studies to establish clear indications, optimize its use, and promote its inclusion in pediatric respiratory management guidelines.