High Flow Nasal Cannula (HFNC) in bronchiolitis (1 mo - 2 years)
Inclusion Criteria
- Clinical diagnosis of bronchiolitis
Exclusion Criteria
- History of abnormal airway anatomy
- Complex past medical history (pulmonary, cardiac, ENT or other)
Upper airway suctioning and reassessment in 30 min
- Start HFNC
- 2 L/kg/min (up to 35 L per min max)
- 60% FiO2 (titrate spO2 between 92-97%)
- 1 hour minimum on HFNC
- Admit to floor vs. ICU based on institution policies and physician assessment
- Reassess RS in one hour
Potential complications
- Abdominal distension
- Aspiration
- Barotrauma
- Pneumothorax (although less common than with intubation/ventilation)
ISTAT Venous Blood Gas, Serum
Off pathway, continue supportive care for bronchiolitis
Reassessment and Respiratory Score
Patient in severe respiratory distress?
Despite delivering high oxygen concentrations, patients on HFNC may still develop respiratory acidosis from poor ventilation and patients with worsening symptoms (signs of respiratory failure, tachycardia, etc.) should undergo blood gas analysis and potentially transfer to different respiratory support modalities.
Begin resuscitation, consider BiPAP vs. intubation
Admit to ICU
