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

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.