For a baby with severe bronchiolitis, a common and scary winter virus, getting off breathing support is a major step toward going home. But without clear guidelines, doctors might keep babies on that support longer than needed. This study tested a new approach: giving nurses a simple checklist to decide when to start reducing the high-flow oxygen support. The checklist used two scores—one for overall sickness and one for breathing effort—to tell nurses when a baby was stable enough to begin weaning. The result? Babies whose care followed this nurse-driven plan spent significantly less time on the breathing support—about 34 hours compared to 50 hours for babies receiving standard care. Their weaning process also started much earlier. Most importantly, these babies spent less time in the intensive care unit and in the hospital overall. The study found no increase in the need for more aggressive breathing support or in readmission rates, meaning the faster weaning didn't come at a safety cost. Nurses reported high satisfaction with the protocol and followed it closely. This suggests that empowering bedside nurses with clear, standardized tools can safely streamline care for these very sick infants.
Nurse-driven HFNC weaning protocol cuts therapy duration by 16 hours, hospital stay by 1 day in bronchiolitis infantsCan letting nurses decide when to reduce breathing support help babies with bronchiolitis get home faster?
AI-generated summary of the cited source, checked by automated accuracy review. How we work
Key Takeaway
Implement a structured, nurse-driven HFNC weaning protocol using WBSS and ROX index to reduce therapy duration and hospital stay in infants with severe bronchiolitis.
This prospective, randomized controlled trial evaluated whether a nurse-driven high-flow nasal cannula (HFNC) weaning protocol reduces HFNC duration and hospitalization in infants with severe bronchiolitis. The 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 (n=55 per group, total n=110). The intervention involved structured assessments using the Wang Bronchiolitis Severity Score (WBSS) and the ROX index (SpO2/FiO2 divided by respiratory rate), with trained nurses initiating 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. Results showed the nurse-driven group had a 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 also reduced. No significant differences were found in NIV use (p=.670), intubation (p=.450), or readmissions (p=.100). Nurse satisfaction with the protocol was 96.0%, and protocol adherence was 92.0%. The study concluded that a nurse-driven HFNC protocol is associated with reduced therapy duration and hospitalization in infants with bronchiolitis without increasing adverse outcomes. The trial was registered on ClinicalTrials.gov (NCT06621641) on November 22, 2025.
What this means for you:
A simple nurse-led checklist safely cut time on breathing support and shortened hospital stays for babies with severe bronchiolitis. More on Bronchiolitis
Systematic review maps 50 most-cited articles on pediatric respiratory infections
Most cited research on child respiratory infections comes from US, China, Canada
This systematic bibliometric review analyzed the 50 most-cited articles on pediatric respiratory infections. Key findings show a predominanc…
A review of 50 top-cited articles on pediatric respiratory infections shows most research comes from just three countries.
De-implementation of low-value bronchiolitis practices showed sustained adherence two years post-trial in a cluster RCT follow-up
Doctors Stick to Better Bronchiolitis Care—2 Years Later
This cluster randomised controlled trial (cRCT) follow-up study assessed the sustainability of de-implementing low-value bronchiolitis pract…
It’s 2 a.m. in a busy children’s hospital.
RT-RN HFNC weaning pathway linked to shorter PICU stay in critical bronchiolitis
Could a new weaning plan help children leave the ICU faster during bronchiolitis?
This retrospective, single-center pre-post analysis evaluated a respiratory therapist-registered nurse high-flow nasal cannula weaning pathw…
A new weaning plan helped babies with bronchiolitis spend fewer hours in the ICU compared to before the plan started.
View Original Abstract ↓
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.
High-Dose Vitamin D and Low-Dose Vitamin A May Reduce Bronchopulmonary Dysplasia in Preterm Infants
High-Dose Vitamin D May Reduce BPD in Preterm Infants
Related in Pediatrics
Congenital cytomegalovirus is associated with a 10-fold increased risk of vestibular changes in children
Children with congenital cytomegalovirus face higher risk of balance issues
This meta-analysis of 8 observational studies examined the association between congenital cytomegalovirus (cCMV) and vestibular outcomes in …
Children born with a specific virus may face much higher risks for inner ear and balance problems, though more research is needed to confirm…
Ambulatory hypertension in pediatric chronic kidney disease patients increases risk of left ventricular hypertrophy
High Blood Pressure Linked to Heart Changes in Children
This meta-analysis of 51 studies involving 6509 children with chronic kidney disease found that ambulatory hypertension is associated with i…
New data shows a strong link between high blood pressure and heart muscle thickening in children with chronic kidney disease.
Early enteral feeding reduces hospital stay by 3.53 days and speeds time to full feeds
Early feeding helps children recover faster after intestinal surgery
This meta-analysis of randomized controlled trials involving 704 pediatric patients found that early enteral feeding (within 48 hours) signi…
Starting tube feedings within 48 hours of intestinal surgery can help children reach full feeds faster and spend less time in the hospital.
NICU noise levels frequently exceed recommended limits and primarily originate from alarms and respiratory devices
NICU noise levels often exceed safety limits for preterm infants
This systematic review of 113 studies identifies alarm systems and respiratory support as primary sources of high-level noise in NICUs. Whil…
Most neonatal intensive care units have noise levels much higher than recommended, especially from alarms and breathing equipment.
From Other Specialties
Individualized six-phase antithrombotic strategy leads to left ventricular thrombus resolution and neurological recovery
New strategy helps manage heart blood clots after heart attack
This case report describes an individualized six-phase antithrombotic strategy for a 27-year-old male with myocardial infarction, stroke, hy…
A tailored six-phase treatment plan helped a young man recover fully from a stroke and heart attack while successfully clearing dangerous bl…
Heterogeneous definitions and clinical inconsistencies currently hinder the accurate identification of treatment-resistant depression
New ways to define treatment resistant depression are emerging
This narrative review examines the phenotypic definition of treatment-resistant depression (TRD) and its associated biological correlates. T…
Doctors struggle to treat some types of depression because the current definition is inconsistent. New research looks at how biology and beh…
HIFU combined with ethanol ablation or GnRH-a improves intraoperative outcomes for adenomyosis treatment
HIFU Combined With Medication Shows Better Results for Adenomyosis
This network meta-analysis of 1,685 patients evaluated HIFU combined with various medications compared to HIFU alone for adenomyosis. The an…
Combining high-intensity focused ultrasound (HIFU) with specific medications may improve treatment outcomes for people with adenomyosis.
Risk-optimized use of Janus kinase inhibitors in Japanese patients with rheumatoid arthritis depends on comorbidities
New evidence helps doctors choose safer arthritis treatments for seniors
This narrative review examines the safety and risk profile of Janus kinase inhibitors (JAKi) for rheumatoid arthritis specifically within th…
Doctors are moving toward personalized plans for rheumatoid arthritis, focusing on a patient's specific health risks rather than just their …