From Floor to Intensive Care Unit: Unpacking the Real Impact of High-Flow Nasal Cannula on Bronchiolitis Triage.
Most infants started on high-flow nasal cannula for bronchiolitis avoided further escalation.
From Floor to Intensive Care Unit: Unpacking the Real Impact of High-Flow Nasal Cannula on Bronchiolitis Triage.
High-flow nasal cannula (high-flow nasal cannula) therapy is increasingly used for infants with bronchiolitis on general pediatric wards, yet factors associated with pediatric intensive care unit (pediatric intensive care unit) transfer and escalation beyond high-flow nasal cannula remain poorly defined.
We conducted a retrospective cohort study of children younger than 24 months of age admitted with bronchiolitis to a tertiary children's hospital pediatric ward between January 2020 and October 2022, who received high-flow nasal cannula ≥0.5 L/kg/min.
Among 200 patients (median age, 7 months; median weight, 7.7 kg), 51.5% were transferred to the pediatric intensive care unit, whereas 13.5% required escalation beyond high-flow nasal cannula.
Height, weight, and initial high-flow nasal cannula flow were not independently associated with pediatric intensive care unit admission nor escalation past high-flow nasal cannula in the adjusted models.
Most infants with bronchiolitis initiated on high-flow nasal cannula on the pediatric floor do not require escalation beyond high-flow nasal cannula.
These findings support the need for standardized, physiology-based triage criteria rather than reliance on fixed high-flow nasal cannula flow thresholds to optimize pediatric intensive care unit use and equity of care.