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High flow in bronchiolitis, but how high? What flow rates should we use?
  1. Fawaz Arshad
  1. Sheffield Children’s NHS Foundation Trust, Sheffield S10 2TH, UK
  1. Correspondence to Dr Fawaz Arshad, Sheffield Children’s NHS Foundation Trust, Sheffield S10 2TH, UK; fawaz.arshad{at}nhs.net

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Clinical scenario

You are the registrar working on-call in a district general hospital. It is the middle of winter and well into ‘bronchiolitis season’. You have been asked to review a 3-month-old 6 kg baby with moderate to severe bronchiolitis clerked by the senior house office. They have already been placed on reduced-volume nasogastric (NG) feeds but continue to have a severe work of breathing with an FiO2 of 40%. You feel they are a candidate for high-flow nasal cannula support. The senior nurse asks you if you want to start at 15 L flow. You recall being told 2 L/min/kg is the ‘dose’ of high flow recommended but are unsure what the evidence is.

Structured question

In children under 2 years of age with bronchiolitis requiring high-flow nasal cannula support (population), do higher or lower weight-based flow rates (intervention) compared with 2 L/min/kg (comparison) affect length of hospital stay and need for escalation of treatment (outcome)?

Search methods

MEDLINE (1996–April 2019) and EMBASE (1996–April 2019) were searched using the OVID interface. CINAHL using EBSCO (1981–April 2019) and the Cochrane Library were also searched. Search terms used were (Bronchiolitis/ OR broncholit* OR bronchopneum* OR respiratory syncytial virus/ OR rsv OR respiratory syncytial virus*) AND (Positive pressure respiration/ OR continuous positive airway pressure/ OR continuous positive airway pressure* OR cpap OR ncpap OR ((non invasive OR noninvasive) adj5 (respirat* OR ventilat*)) OR nppv OR nippv OR ((highflow OR high flow)adj5 nasal)) OR hfnc …

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