Bronchiolitis Clinical Pathway – Emergency Department and Inpatient – High-Flow Nasal Cannula (HFNC)

Bronchiolitis Clinical Pathway – Emergency Department and Inpatient – High-Flow Nasal Cannula (HFNC)

High-Flow Nasal Cannula (HFNC)

  • HFNC is indicated to reduce work of breathing in infants with bronchiolitis or other lower respiratory conditions. Evidence of benefit for children > 12 mos is lacking.
  • Initiation of HFNC should be based on severe respiratory distress on repeated assessments not resolved with suctioning and supportive care
    • Pausing to reassess has been shown to successfully reduce unnecessary use of HFNC
    • Prior to initiation in ED, Attending assessment required
  • HFNC should be titrated to minimum settings required to relieve work of breathing, usually 1.5-2 L/kg/min with a weight-based maximum.
  • HFNC is an expensive and resource-intensive therapy which should be weaned off as soon as possible once children are improving.
  • Enteral feeding is safe and effective for infants receiving HFNC unless worsening with signs of impending respiratory failure.