In Reply The point made by O’Brien et al in response to the Viewpoint “High-Flow Nasal Cannula Therapy for Pediatric Patients With Bronchiolitis: Time to Put the Horse Back in the Barn”1 around the safety of high-flow nasal cannula (HFNC) is quite valid and well taken. The risks posed by HFNC use in most clinical settings are likely quite low, although they are certainly not zero.2,3 Magnitude of risk aside, the relevant question in this situation could be posed as follows: if a patient does not clearly stand to benefit from a therapeutic strategy, should we accept even small risks from its use? This is a particularly salient question given the context of increasing use of HFNC in bronchiolitis without evidence of benefit, at least in North America.4,5 If one considers unnecessary cost as a harm, we can draw an even stronger conclusion that it is in the patient’s best interest to avoid early use of HFNC in bronchiolitis because most patients can do so without any harm at all.1
Ralston SL. High-Flow Nasal Cannula as Rescue Therapy in Bronchiolitis—Reply. JAMA Pediatr. 2021;175(2):208. doi:10.1001/jamapediatrics.2020.2579
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