High Flow Nasal Cannula Weaning in Acute Bronchiolitis

Acute bronchiolitis is the most common cause of hospitalization among infants in Finland, with its primary etiology being the RS- virus. Acute bronchiolitis is defined in Finland as an infant's first respiratory distress before the age of 1. There is no effective pharmacological treatment for acute bronchiolitis. High-flow nasal cannula therapy has been shown in large randomized trials to reduce the risk of intensive care unit admission for children. High-flow nasal cannulas are typically used at a flow rate of 2 liters per kilogram per minute. Despite widespread use, there is insufficient evidence to determine whether high-flow therapy should be discontinued abruptly or gradually tapered. Observational studies indicate that the majority of units opt for abrupt discontinuation. Common criteria for discontinuation include weaning off supplemental oxygen and maintaining normal oxygenation on room air for 4-6 hours. Gradual weaning has been shown in observational studies to prolong hospitalization compared to immediate cessation of therapy. In a randomized controlled trial conducted in a pediatric intensive care unit, direct discontinuation shortened the duration of treatment by up to two days. However, there have been no previous randomized trials conducted on bronchiolitis patients.

Inclusion criteria

• Clinically diagnosed acute bronchiolitis
• High flow nasal cannula treatment has lasted for at least 12 hours
• Measured saturation 95 or more with room air
• High flow rate is maximum 2l/kg/min
• The treating doctors considers the infant suitable to be without high flow

Exclusion criteria

• Major congenital anomaly of lungs, hearts or diaphragm
• Bacterial pneumonia
• Parents do not give consent