title: Non-invasive respiratory support for infants with bronchiolitis: a national survey of practice.
abstract: Bronchiolitis is a common respiratory illness of early childhood. For most children it is a mild self-limiting disease but a small number of children develop respiratory failure. Nasal continuous positive airway pressure (nCPAP) has traditionally been used to provide non-invasive respiratory support in these children, but there is little clinical trial evidence to support its use. More recently, high-flow nasal cannula therapy (HFNC) has emerged as a novel respiratory support modality. Our study aims to describe current national practice and clinician preferences relating to use of non-invasive respiratory support (nCPAP and HFNC) in the management of infants (<12 months old) with acute bronchiolitis.
  
  
  
  We performed a cross-sectional web-based survey of hospitals with inpatient paediatric facilities in England and Wales. Responses were elicited from one senior doctor and one senior nurse at each hospital. We analysed the proportion of hospitals using HFNC and nCPAP; clinical thresholds for their initiation; and clinician preferences regarding first-line support modality and future research.
  
  
  
  The survey was distributed to 117 of 171 eligible hospitals; 97 hospitals provided responses (response rate: 83%). The majority of hospitals were able to provide nCPAP (89/97, 91.7%) or HFNC (71/97, 73.2%); both were available at 65 hospitals (67%). nCPAP was more likely to be delivered in a ward setting in a general hospital, and in a high dependency setting in a tertiary centre. There were differences in the oxygenation and acidosis thresholds, and clinical triggers such as recurrent apnoeas or work of breathing that influenced clinical decisions, regarding when to start nCPAP or HFNC. More individual respondents with access to both modalities (74/106, 69.8%) would choose HFNC over nCPAP as their first-line treatment option in a deteriorating child with bronchiolitis.
  
  
  
  Despite lack of randomised trial evidence, nCPAP and HFNC are commonly used in British hospitals to support infants with acute bronchiolitis. HFNC appears to be currently the preferred first-line modality for non-invasive respiratory support due to perceived ease of use.
authors.affiliation: Bristol Royal Hospital for Children, University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom.
authors.forename: H
authors.initials: H
authors.lastname: Turnham
authors.affiliation: Great North Children's Hospital, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle University, Newcastle upon Tyne, UK.|Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK.
authors.forename: R S
authors.initials: RS
authors.lastname: Agbeko
authors.affiliation: Country Durham and Darlington NHS Foundation trust, Darlington, UK.
authors.forename: J
authors.initials: J
authors.lastname: Furness
authors.affiliation: Southampton Children's Hospital, Southampton, UK.
authors.forename: J
authors.initials: J
authors.lastname: Pappachan
authors.affiliation: Institute of Child Health, University College London, GAP unit, Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK. a.sutcliffe@ucl.ac.uk.
authors.forename: A G
authors.initials: AG
authors.lastname: Sutcliffe
authors.affiliation: Children's Acute Transport Service, Great Ormond Street Hospital NHS Foundation Trust, London, UK.
authors.forename: P
authors.initials: P
authors.lastname: Ramnarayan
mesh_terms: D001988:Bronchiolitis / Q000628:therapy*; D045422:Continuous Positive Airway Pressure / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D004739:England; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D010102:Oxygen Inhalation Therapy / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D014852:Wales
keywords: Bronchiolitis; Critical care; Non-invasive respiratory support; Respiratory failure