The Appropriate Use of High-Flow Nasal Cannula in Bronchiolitis: A Delphi Approach

Area of Science:

• Pediatric Pulmonology
• Critical Care Medicine
• Evidence-Based Medicine

Background:

• Significant variation exists in the national use of high-flow nasal cannula (HFNC) for pediatric bronchiolitis.
• Existing literature supports specific HFNC practices, yet clinical application remains inconsistent.

Purpose of the Study:

• To develop evidence-based recommendations for the appropriate and necessary use of HFNC in hospitalized children with bronchiolitis.
• To standardize HFNC utilization and improve patient outcomes.

Main Methods:

• Employed the RAND/UCLA Appropriateness Method, including an extensive literature review.
• Convened a multidisciplinary expert panel (nursing, respiratory therapy, medicine) with diverse clinical expertise.
• Conducted three rating sessions and a moderated meeting for panelists to evaluate recommendations.

Main Results:

• A 15-member panel assessed 60 recommendations for HFNC initiation, reassessment, escalation, and de-escalation in bronchiolitis.
• Agreement on appropriateness was reached for 52 of 60 recommendations, and on necessity for 46 of 52.
• Key agreements included initiating HFNC for refractory hypoxemia/impending respiratory failure, specific flow rates (1.5-2 L/kg/min), and discontinuation criteria.

Conclusions:

• A national expert consensus was achieved on the appropriateness and necessity of HFNC parameters for pediatric bronchiolitis.
• These standardized recommendations can optimize clinical practice and reduce non-specific HFNC application.