Weaning with meaning: optimising respiratory support de-escalation to improve outcomes in critically ill children with bronchiolitis
- 1Pediatric Critical Care Medicine, Baylor College of Medicine, Houston, Texas, USA
- 2Pediatric Critical Care Medicine, Texas Children’s Hospital The Woodlands, The Woodlands, Texas, USA
Abstract
Patients with bronchiolitis requiring high-flow nasal cannula (HFNC) and/or continuous positive airway pressure (CPAP) in the paediatric intensive care unit (PICU) are common. In our institution, patients receiving CPAP require PICU-level care. Weaning practices are variable. We designed the ‘HFNC challenge’ to standardise weaning. We aimed to reduce CPAP utilisation, time spent nil by mouth (NPO) and PICU medical length of stay (LOS) for previously healthy bronchiolitis patients aged less than 1 year by 20% within 6 months.
We conducted a retrospective chart review to identify patients between April 2021 and July 2022 for preintervention baseline data. Exclusion criteria included chronic respiratory support needs, chronic medical conditions, progression to intubation and bilevel positive airway pressure utilisation. Postintervention data were collected retrospectively from August 2022 to February 2025. Balancing measures included resumption of CPAP support following HFNC challenge within 24 hours and readmission to the PICU during the hospitalisation.
445 patients were identified during the study. 345 patients met inclusion criteria preintervention and postintervention. The weaning protocol was adopted for 128/236 patients (54%). Median time spent on CPAP decreased from 27 hours to 16 hours. Median time spent NPO decreased from 39 hours to 24 hours. Median medical PICU LOS decreased from 41 hours to 35 hours. Preintervention, 0/109 (0%) patients required reinitiation of CPAP and 1/109 (0.9%) patients required readmission to the PICU. Postintervention, 11/236 (4.7%) patients required reinitiation of CPAP and 4/236 (1.7%) required readmission to the PICU.
Implementation of the HFNC challenge was associated with reductions in CPAP utilisation, time spent NPO and PICU LOS. These findings should be interpreted in the context of variable protocol adoption and warrant further study.
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BibTeX
@article{pymento2026weaning,
title = {{Weaning with meaning: optimising respiratory support de-escalation to improve outcomes in critically ill children with bronchiolitis}},
author = {Craig Pymento and Katherine Taylor and Mark Riccioni and Bridgette Nava and Michelle Keilman and Christian Erikson},
journal = {BMJ Open Quality},
year = {2026},
month = nov,
doi = {10.1136/bmjoq-2026-004219},
url = {https://doi.org/10.1136/bmjoq-2026-004219},
note = {CC BY-NC 4.0},
}
RIS
TY - JOUR
TI - Weaning with meaning: optimising respiratory support de-escalation to improve outcomes in critically ill children with bronchiolitis
AU - Craig Pymento
AU - Katherine Taylor
AU - Mark Riccioni
AU - Bridgette Nava
AU - Michelle Keilman
AU - Christian Erikson
PY - 2026
DA - 2026/11/02
JO - BMJ Open Quality
DO - 10.1136/bmjoq-2026-004219
UR - https://doi.org/10.1136/bmjoq-2026-004219
AB - Patients with bronchiolitis requiring high-flow nasal cannula (HFNC) and/or continuous positive airway pressure (CPAP) in the paediatric intensive care unit (PICU) are common. In our institution, patients receiving CPAP require PICU-level care. Weaning practices are variable. We designed the ‘HFNC challenge’ to standardise weaning. We aimed to reduce CPAP utilisation, time spent nil by mouth (NPO) and PICU medical length of stay (LOS) for previously healthy bronchiolitis patients aged less than 1 year by 20% within 6 months. We conducted a retrospective chart review to identify patients between April 2021 and July 2022 for preintervention baseline data. Exclusion criteria included chronic respiratory support needs, chronic medical conditions, progression to intubation and bilevel positive airway pressure utilisation. Postintervention data were collected retrospectively from August 2022 to February 2025. Balancing measures included resumption of CPAP support following HFNC challenge within 24 hours and readmission to the PICU during the hospitalisation. 445 patients were identified during the study. 345 patients met inclusion criteria preintervention and postintervention. The weaning protocol was adopted for 128/236 patients (54%). Median time spent on CPAP decreased from 27 hours to 16 hours. Median time spent NPO decreased from 39 hours to 24 hours. Median medical PICU LOS decreased from 41 hours to 35 hours. Preintervention, 0/109 (0%) patients required reinitiation of CPAP and 1/109 (0.9%) patients required readmission to the PICU. Postintervention, 11/236 (4.7%) patients required reinitiation of CPAP and 4/236 (1.7%) required readmission to the PICU. Implementation of the HFNC challenge was associated with reductions in CPAP utilisation, time spent NPO and PICU LOS. These findings should be interpreted in the context of variable protocol adoption and warrant further study.
SN - 2399-6641
ER -