Clinical Interventions During Inter-hospital Transfer of Infants With Moderate-to-Severe Bronchiolitis: Implications...

Bronchiolitis is a leading cause of hospitalisation and paediatric intensive care admissions in infants. Moderate-to-severe cases often require inter-hospital transfer for respiratory support, usually organised by specialised paediatric emergency transport services (PETS). The optimal composition of transport teams, whether nurse-led or medicalised, remains uncertain.

To identify predictive factors available during the regulation call that can help determine when an inter-hospital transfer of infants with moderate-to-severe bronchiolitis can be safely conducted by a nurse-led team without a paediatrician, by predicting the need for clinical intervention during transport.

A retrospective observational study was conducted from 2021 to 2023 within the PETS of a French University Hospital. Infants under 2 years transferred for moderate-to-severe bronchiolitis were included. The primary outcome was the occurrence of a clinical intervention during transport, defined as any event requiring physician-level management: apnoea requiring manual ventilation, fluid bolus, initiation of two-level non-invasive ventilation or endotracheal intubation. Clinical and paraclinical parameters available at the regulation call-particularly ventilatory support mode, FiO₂ and blood gas values-were analysed for their ability to predict the occurrence of such interventions using receiver operating characteristic (ROC) analysis.

Among 167 included infants (mean age 157 ± 169 days; weight 5.9 ± 2.7 kg), 20 (12%) required a clinical intervention. Higher FiO₂ (51.3% ± 19.3% vs. 34.8% ± 10.2%; p < 0.01), lower pH (7.30 ± 0.08 vs. 7.34 ± 0.07; p = 0.03) and higher pCO₂ (62.9 ± 17.9 vs. 49.6 ± 11.2 mmHg; p = 0.01) were associated with interventions. The presence of high-flow nasal cannula (HFNC) with FiO₂ > 40%, or continuous positive airway pressure (CPAP) with FiO₂ > 35% or pCO₂ > 65 mmHg predicted the need for a medicalised team (AUC = 0.83; sensitivity 90%, specificity 78%, negative predictive value 98%).

Most inter-hospital transfers of infants with moderate-to-severe bronchiolitis can be safely undertaken by nurse-led teams when predefined respiratory or blood gas thresholds are not exceeded.

This study provides objective criteria to guide decision-making regarding team composition during the regulation of inter-hospital transfers for infants with moderate-to-severe bronchiolitis. FiO₂ and pCO₂ thresholds measured at the initial call can help identify cases requiring physician presence, while allowing most transfers to be safely conducted by nurse-led teams. These results support the development of standardised triage protocols and strengthen the role of advanced paediatric critical care nurses in retrieval medicine. Integrating such evidence-based criteria into practice could optimise human resources, maintain safety and improve response times in paediatric emergency transport systems.