Bronchiolitis is a common and often serious disease that unfortunately does not seem to be impacted by targeted therapy. We have certainly tried our share of remedies including albuterol, epinephrine, corticosteroids, and hypertonic saline, but none of them seem effective in randomized clinical trials. Enter high flow nasal cannula (HFNC) use—which is now spreading outside of the ICU. How do we know this? Kalburgi et al (10.1542/peds.2019-4083) alert us to the popularity of HFNC use by reporting on data that came from a survey of the Pediatric Research in Office Settings network in which 68% of 114 sites responded. Of these 68 sites, almost half reported using HFNC in the pediatric inpatient non-ICU setting.
Yet in an accompanying commentary by bronchiolitis experts Drs. JoAnna Leyenaar and Shawn Ralston (10.1542/peds.2020-021188), the authors summarize studies suggesting HFNC is of little benefit. They also hypothesize why individual hospitals are designing their own hospital by hospital local protocols to justify its use since evidence-based studies do not justify such use. HFNC remains a modality that may be doing more harm than good. Is your local children’s hospital using HFNC treatment for bronchiolitis? Have you found it of benefit to your patients or did you stop using it because no benefits were found? We welcome your comments to this blog on our website or via our social media sites (Facebook, Twitter, or Instagram).