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

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.

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.