Use of high-flow nasal cannula in infants with viral bronchiolitis outside pediatric intensive care units
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.
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
KeywordsBronchiolitis 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
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.
For this type of study, formal consent and ethics committee are not required.
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