Noninvasive Respiratory Support Weaning in Infants With Severe Bronchiolitis: High Flow Nasal Cannula May Reduce the Length of Stay.

INTRODUCTION

The aim is to describe weaning procedures, weaning failure rates, and predictors and consequences of weaning failure in infants admitted to pediatric intensive care units (PICUs) for severe bronchiolitis.

METHODS

This is a multicenter prospective observational cohort study in five PICUs in French university hospitals. Consecutive infants aged 3 days to 6 months admitted between November 2020 and April 2022 with a clinical diagnosis of severe bronchiolitis requiring noninvasive ventilatory support by bilevel positive airway pressure (BiPAP), continuous positive airway pressure (CPAP), or high-flow nasal cannula (HFNC).

RESULTS

Demographic and clinical data were collected prospectively. Weaning strategies were classified as direct, HFNC for de-escalation, and gradual with decreasing support levels. Multivariate analysis was performed to identify independent predictors of weaning failure. Of the 135 included patients (median age 1 [1-2] months), 60 (44%), 49 (36%), and 26 (19%) were managed by HFNC-based, direct, and gradual weaning, respectively. Bronchiolitis severity was similar in the three groups. By multivariate analysis, predictors of weaning failure was gradual weaning (odds ratio, 10.56 [2.87-38.86], p < 0.01), while apnea at admission (0.26 [0.07-0.96], p = 0.04) and younger age (0.44 [0.23-0.84], p = 0.02) were protective factors. PICU length of stay was shorter with HFNC-based weaning (3.8 [1.9-5.4] days vs. 4.3 [3.0-6.9] and 5.1 [3.8-7.4] with direct and gradual weaning, respectively, p = 0.02).

CONCLUSIONS

Among patients with severe bronchiolitis, a weaning strategy using HFNC for de-escalation was associated with shorter PICU stays. Whether this method also decreases the risk of weaning failure deserves investigation.