Nurse-driven HFNC weaning protocol cuts therapy duration by 16 hours, hospital stay by 1 day in bronchiolitis infants

UNLABELLED: The purpose of this study was to evaluate whether a nurse-driven high-flow nasal cannula (HFNC) weaning protocol reduces HFNC duration and hospitalization in infants with severe bronchiolitis. This prospective, randomized controlled study was conducted in two tertiary pediatric intensive care units (PICUs) during a single bronchiolitis season. Infants aged 1-24 months requiring HFNC for severe bronchiolitis were randomized to standard care or a nurse-driven protocol group. The intervention included structured assessments using the Wang Bronchiolitis Severity Score (WBSS), and ROX index (SpO/FiO divided by respiratory rate). Trained nurses initiated weaning based on predefined criteria. The primary outcome was total HFNC duration. Secondary outcomes included time to first weaning, PICU and hospital length of stay, need for non-invasive ventilation (NIV), intubation, readmission rates, nurse satisfaction, and protocol adherence. A total of 110 patients were included (55 per group). The nurse-driven group had significantly shorter median HFNC duration (34.00 h vs. 50.00 h, p = .001) and earlier weaning initiation (12.00 h vs. 20.00 h, p < .001). PICU stay (3.00 vs. 4.00 days, p = .005) and hospital stay (6.00 vs. 7.00 days, p = .001) were reduced. No significant differences were found in NIV use (p = .670), intubation (p = .450), or readmissions (p = .100). Nurse satisfaction was 96.0%, and protocol adherence was 92.0%. CONCLUSION:  A nurse-driven HFNC protocol is associated with reduced therapy duration and hospitalization in infants with bronchiolitis without increasing adverse outcomes. Empowering nurses with standardized tools may support timely and effective respiratory care in the PICU. TRIAL REGISTRATION: ClinicalTrials.gov (NCT06621641), registered on November 22, 2025. WHAT IS KNOWN: • High-flow nasal cannula (HFNC) therapy is widely used in infants with bronchiolitis, despite inconsistent evidence regarding its impact on length of stay and the need for escalation of care. • Lack of standardized weaning criteria may contribute to prolonged HFNC use and increased resource utilization. WHAT IS NEW: • This randomized controlled study demonstrates that a nurse-driven HFNC weaning protocol significantly reduces HFNC duration and hospital length of stay in infants with severe bronchiolitis. • Structured, score-guided nurse-driven weaning can be safely implemented in the PICU without increasing the need for non-invasive ventilation or intubation.