From Floor to Intensive Care Unit - Unpacking the Real Impact of High-Flow Nasal Cannula on Bronchiolitis Triage

Oct 12, 2026

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Research examines how high-flow nasal cannula (HFNC) is used for infants with bronchiolitis on pediatric wards and why some cases progress to PICU transfer or escalation beyond HFNC. A retrospective cohort of children under 24 months treated with HFNC ≥0.5 L/kg/min from January 2020 to October 2022 assessed factors linked to PICU admission, respiratory support escalation, oxygen duration, and hospital length of stay. Most infants did not require escalation; delayed time to peak flow predicted escalation, and PICU admission correlated with longer oxygen therapy and stay. Findings support standardized, physiology-based triage instead of fixed HFNC flow thresholds.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages9

Reading Time23 min

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Introduction

Methods

RESEARCH ARTICLE From Floor to Intensive Care Unit:Unpacking theReal Impact of High-Flow Nasal Cannula onBronchiolitis Triage Sarah Householder,MD,'Clea Harris,MD.¹2Max Tarica,MD,Magna Dias.MD,Oliver Karam,MD,PhD⁵ B5IRACTBACKGROUND:High-fow nasal cannula(HFNC)therapy is increasingly used for infants withbronchiolitis on general pediatric wards,yet factors associated with pediatric intensive care unit(PICU)transfer and escalation beyond HFNC remain poorly defined.Our aim was to characterizeclinical trajectories of infants started on HFNC on the pediatric floor and identify factorsassociated with PICU admission and escalation of respiratory support. METHODS:We conducted a retrospective cohort study of children younger than z4 months ofage admiitted with bronchiolitis to a tertiary children's hospital pediatric ward between January202o and October 2022,who received HFNC≥0.5 L/kg/min.Multivariable logistic and linearregression models were used to identify factors associated with PICU admission,escalationbeyond HFNC,length of oxygen requirement,and hospital length of stay. RESULTS:Among 200 patients(median age,7 months;median weight,7.7 kg).51.5%weretransferred to the PICU,whereas 13.5%required escalation beyond HFNC.Most (86.5%)weresuccessfully weaned from HFNC without escalation past HFNC.Height,weight,and initialHFNC flow were not independently associated with PICU admission nor escalation past HFNC inthe adjusted models.However,longer time from HFNC initiation to peak flow rate wasindependently associated with escalation beyond HFNC.PICU admission,even without escalationpast HFNC,was associated with significantly longer hospital length of stay and duration of oxygentherapy CONCLUSION:Most infants with bronchiolitis initiated on HFNC on the pediatric floor do notrequire escalation beyond HFNC.These findings support the need for standardized,physiology-based triage criteria rather than reliance on fixed HFNC fow thresholds to optimize PICU useand equity of care. Address correspondence to:Sarah Householder;MD.Department of Pediatrics,Yale School of Medicine,333 Cedar St,New Haven.CT 06520 sarah householder@yale edu Dr Householder contributed to the project design,managed the project,interpreted the data,wrote the initial manuscript andcantributed to subsequent revisions.Dr Harris contributed to project design,conducted analyses interpreted the data,andcontributed to the initial manuscript and subsequenf revisions.Dr Tarica contribuled to project design and interpreted the uata.Dr Dias contributed to project design and revised the manuscript.Dr Karam conceived of the project.contributed to projocf approachconducted analyses,revised the manuscript,and supervised the project. CONFLICT DF INTEREST DISCLOSURES:The authors have no conficts of interest relevant to this article to disclose FUNDING:The authors have no funding relevant to this study to disclose Accepted for Publication Date:March 25,2026 https//doi.org/10.1542/hpeds.2025-008983 Copyright ◎2026 by the American Academy of Pediatrics Department of Pediatrics. Yale School of Medicime, Naw Haven,Gonnecticuz Departmont of Podiatries Mohns Mopkins University School of Medicine, Baltimore,Maryland Department of Pediatrics, Emory School of Medicine, Atianra,Georgiu Pediatrio Hospital Medicine.Department of Pediatrics.Yzle Schoo of Medicine.New Haven Connecticul Pediotric Gritical Care Mooicino.Doparimant of Pediatrics Yale Schooi of Medicne Now Haven, Connecticut # INTRODUCTION Bronchiclitis is the leading cause of infant hospitalization in high-income countries,accounting for approximately 17%of hospitalizations for children younger than 2 years old.'Despite this prevalence,targeted therapies remains limited,and management focuses onsupportive care for hypoxemia,increased work of breathing,anddehydration-3 Over the last decade,high-flow nasal cannula(HFNC)has emergedas a therapy posited to reduce the work of bre

FAQs

What was the study aiming to determine about HFNC use in bronchiolitis?

The study characterized clinical trajectories of infants started on HFNC on the pediatric floor and identified factors associated with PICU admission and escalation of respiratory support beyond HFNC.

How was the retrospective cohort defined and what treatments were included?

Children younger than 24 months with bronchiolitis admitted to a tertiary pediatric ward between January 2020 and October 2022 were included if they received HFNC ≥0.5 L/kg/min.

Which factor predicted escalation beyond HFNC?

Longer time from HFNC initiation to peak flow rate was independently associated with escalation beyond HFNC.

Oct 12, 2026

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