European Journal of Pediatrics

, Volume 178, Issue 10, pp 1479–1484 | Cite as

Use of high-flow nasal cannula in infants with viral bronchiolitis outside pediatric intensive care units

  • Mélanie PanciaticiEmail author
  • Candice Fabre
  • Sophie Tardieu
  • Emilie Sauvaget
  • Marion Dequin
  • Nathalie Stremler-Le Bel
  • Emmanuelle Bosdure
  • Jean-Christophe Dubus
Original Article


High-flow nasal cannula (HFNC) is frequently used in infants with acute viral bronchiolitis outside pediatric intensive care units (PICU). A structured questionnaire was sent out to pediatricians of all public French hospitals with pediatric emergency and/or general pediatric departments on their use of HFNC outside PICU (department using HFNC, number of available devices, monitoring, criteria for initiating or stopping HFNC, and personal comments on HFNC). Of the 166 eligible hospitals, 135 answered (96 general and 39 university hospitals; 81.3%), for a total of 217 answering pediatricians. Seventy-two hospitals (53.3%) used HFNC in acute bronchiolitis outside PICU, particularly, general hospitals (59.4% vs 38.5%), and mostly in pediatric general departments (75%). Continuous patient monitoring with a cardiorespiratory monitor was usual (n = 58, 80%). Nursing staff was responsible for 2.7 children on HFNC and checked vital signs 8.6 times per day. Criteria for HFNC initiation and withdrawal were not standardized. Pediatricians had a positive opinion of HFNC and were willing to extend its use to other diseases.

Conclusion: Use of HFNC outside PICU in infants with acute bronchiolitis is now usual, but urgently requires guidelines.

What is Known:

Acute viral bronchiolitis treatment is only supportive

High-flow nasal cannula (HFNC) is a respiratory support accumulating convincing clinical evidence in bronchiolitis

This latter treatment is usually proposed in pediatric intensive care unit (PICU)

What is New:

HFNC are increasingly used outside PICU in bronchiolitis, particularly, in general hospitals and in pediatric general departments

Pediatricians are enthusiastic about this device, but validated criteria for initiation and withdrawal are lacking

Guidelines for the use of HFNC outside PICU are urgently required


Bronchiolitis High-flow nasal cannula Infant Intensive care 



General hospital center


University hospital center


High-flow nasal cannula


Pediatric emergency department


Pediatric general department


Pediatric intensive care unit


Authors’ contributions

MP, CF, ES, and JCD conceived the study and designed the trial. JCD and EB supervised data collection. ST provided statistical advice on study design and analyzed the data. MP and CF drafted the manuscript, and all authors contributed substantially to its revision. JCD takes responsibility for the paper as a whole.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

For this type of study, formal consent and ethics committee are not required.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Service de Médecine Infantile et Pneumologie pédiatriqueCHU Timone-EnfantsMarseille Cedex 5France
  2. 2.Service d’Evaluation médicale, Pôle de Santé publiqueHôpital de la ConceptionMarseilleFrance
  3. 3.Service de pédiatrieHôpital Saint-JosephMarseilleFrance
  4. 4.IRD, AP-HM, MEPHI, IHU-Méditerranée InfectionAix Marseille UniversitéMarseilleFrance

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