Weaning from noninvasive ventilatory support in infants with severe bronchiolitis: An observational study

Background: The aim of the study was to analyze the weaning success, the type of weaning procedures, and weaning duration in consecutive infants hospitalized in a pediatric intensive care unit over a winter season. Methods: A retrospective observational study was conducted in a pediatric intensive care unit in a tertiary center. Infants hospitalized for severe bronchiolitis were included and the weaning procedure from continuous positive airway pressure (CPAP), noninvasive ventilation (NIV), or high-flow nasal cannula (HFNC) was analyzed. Results: Data from 95 infants (median age, 47 days) were analyzed. On admission, 26 (27%), 46 (49%), and 23 (24%) infants were supported with CPAP, NIV, and HFNC, respectively. Weaning failed in one (4%), nine (20%), and one (4%) infants while supported with CPAP, NIV, or HFNC, respectively (p = 0.1). In infants supported with CPAP, CPAP was stopped directly in five patients (19%) while HFNC was used as an intermediate ventilatory support in 21 (81%). The duration of weaning was shorter for HFNC (17 h, [IQR: 0-26]) than for CPAP (24 h, [14-40]) and NIV (28 h, [19-49]) (p < 0.01). Conclusions: The weaning phase corresponds to a large proportion of noninvasive ventilatory support duration in infants with bronchiolitis. The weaning procedure following a step-down strategy may lead to an increase in the duration of weaning. & COPY; 2023 French Society of Pediatrics. Published by Elsevier Masson SAS. All rights reserved.

Automated summary

This study analyzed the weaning success, weaning procedures, and weaning duration in infants hospitalized in a pediatric intensive care unit over a winter season. The results showed that 27% of infants used CPAP, 49% used NIV, and 24% used HFNC. The duration of weaning was shorter for HFNC compared to CPAP and NIV.