Background: Bronchiolitis is a common respiratory illness of early childhood. For most children it is a mild self-limiting\ndisease but a small number of children develop respiratory failure. Nasal continuous positive airway pressure (nCPAP) has\ntraditionally been used to provide non-invasive respiratory support in these children, but there is little clinical trial evidence\nto support its use. More recently, high-flow nasal cannula therapy (HFNC) has emerged as a novel respiratory support\nmodality. Our study aims to describe current national practice and clinician preferences relating to use of non-invasive\nrespiratory support (nCPAP and HFNC) in the management of infants (<12 months old) with acute bronchiolitis.\nMethods: We performed a cross-sectional web-based survey of hospitals with inpatient paediatric facilities in England and\nWales. Responses were elicited from one senior doctor and one senior nurse at each hospital. We analysed the proportion\nof hospitals using HFNC and nCPAP; clinical thresholds for their initiation; and clinician preferences regarding first-line\nsupport modality and future research.\nResults: The survey was distributed to 117 of 171 eligible hospitals; 97 hospitals provided responses (response rate: 83%).\nThe majority of hospitals were able to provide nCPAP (89/97, 91.7%) or HFNC (71/97, 73.2%); both were available at 65\nhospitals (67%). nCPAP was more likely to be delivered in a ward setting in a general hospital, and in a high dependency\nsetting in a tertiary centre. There were differences in the oxygenation and acidosis thresholds, and clinical triggers such as\nrecurrent apnoeas or work of breathing that influenced clinical decisions, regarding when to start nCPAP or HFNC. More\nindividual respondents with access to both modalities (74/106, 69.8%) would choose HFNC over nCPAP as their first-line\ntreatment option in a deteriorating child with bronchiolitis.\nConclusions: Despite lack of randomised trial evidence, nCPAP and HFNC are commonly used in British hospitals to\nsupport infants with acute bronchiolitis. HFNC appears to be currently the preferred first-line modality for non-invasive\nrespiratory support due to perceived ease of use.
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