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Bronchiolitis - High Flow Nasal Cannula Treatment

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This guideline is to support the use of High Flow Nasal Cannula (HFNC) for patients with bronchiolitis admitted to Starship Children's Hospital. HFNC is being introduced to Starship as part of a clinical trial (the High Flow Nasal Cannula (HFNC) Treatment Management for Viral Bronchiolitis trial).

Information to guide patient selection and treatment

Full details of the study protocol, handbook and education materials are available at http://adhbintranet/ced/research.htm (ADHB staff only).


Starship has developed a guideline to support nursing care for use with the High Flow Nasal Cannula (HFNC) Treatment Management for Viral Bronchiolitis trial


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 HFNC Nursing Care

To determine who to consider commencing on HFNC, refer to the screening flowchart

Care for the control group is summarised in the control group flowchart

Care for the HFNC group is summarised in the high flow group flowchart

How to titrate is summarised in the titration flowchart

For patients on HFNC do not wean the flow rate, only wean the FiO2

Some clinical decisions are left to the discretion of medical staff. The discussion below is to help guide these decisions.

When to determine a patient is a non-responder

  • No specific cut off time is given in the study documents to determine a patient is a non-responder. This is a clinical decision as the appropriate amount of time to wait will vary between patients. Some illustrative examples:
    • Patient 1 starts on HFNC at 60% FiO2. Effort of breathing clearly starts to improve within 30 minutes. FiO2 is able to be weaned quickly. It is appropriate to allow this patient time to see if the patient will manage with FiO2 <40% as there is observed clinical improvement.
    • Patient 2 starts on HFNC at 50% FiO2. Effort of breathing does not improve, and FiO2 requirement increases by 30 minutes. It is appropriate to call for PICU review at this point as there is clinical deterioration.

At any point, if there is concern about the clinical status of the patient, particularly if deteriorating, then call for PICU review

Feeding instructions for patient on HFNC

  • Feeding and fluid management follows standard practice for bronchiolitis.
  • For all patients on HFNC a nasogastric tube (NGT) is inserted.  Regular de-venting of the stomach through aspiration of the NGT needs to be performed every 4 hours at a minimum (including for patients on continuous feeding - therefore requiring a break from feeding every 4 hours to allow time for venting).
  • Feeding commences according to clinical team decision. All NGT feeding commenced should initially be continuous for the first 2 hours, then oral or bolus feeding as clinically determined and according to the treating clinical team.

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Document Control

  • Date last published: 13 July 2015
  • Document type: Clinical Guideline
  • Owner: Greg Williams
  • Editor: Greg Williams
  • Review frequency: 2 years

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