Nasal High-Flow Therapy for Infants With Bronchiolitis Across Australia and New Zealand: A PREDICT and CIRCAN Clinician Survey

Aims: To describe the current clinical practices relating to nasal high-flow therapy (NHF) therapy for infants with bronchiolitis across Australia and New Zealand, with a focus on describing the approach to non-hypoxic infants. Methods: Voluntary online questionnaire distributed to Emergency Department and inpatient unit staff affiliated with the Paediatric Research in Emergency Departments International Collaborative (PREDICT) and Children's Inpatient Research Collaboration of Australia and New Zealand (CIRCAN) networks. The survey explored clinicians' general approach to NHF and included six clinical scenarios to assess self-reported practice patterns. Results: A total of 704 clinicians (386 physicians and 318 nurses) from 42 healthcare services across Australia and New Zealand responded. For non-hypoxic infants with moderate illness, 55% of nursing staff would commence NHF, compared with 24% of doctors (p < 0.001). For hypoxic infants with moderate illness, 70% of nurses compared with 34% of doctors reported initiating NHF (p < 0.001). Nurses were more likely than doctors to consider moderate work of breathing, and worsening tachypnoea (not meeting emergency response criteria), as indications to initiate NHF for non-hypoxic infants, whereas doctors more frequently cited critical work of breathing and apnoea. Key therapeutic objectives of NHF identified were ‘reduced work of breathing’ (96%)and ‘reduced tachypnoea’ (80%).
Conclusions: Substantial variability exists in the clinical application of NHF therapy for infants with bronchiolitis, particularly in cases of moderate illness without hypoxia. Clearer clinical guidelines and better evidence for NHF in non-hypoxic infants may reduce this variability.