Background – Bronchiolitis is a viral lower respiratory illness that, outside of birth hospitalizations, accounts for more hospital admissions in children under 2 than any other diagnosis. This illness, caused by a wide range of viruses, results in congestion, cough, and for some children difficulty breathing resulting in hypoxemia. Guidelines recommend supportive care for bronchiolitis, even in the hospital setting, including supplemental oxygen via nasal canula to maintain oxygen saturations. Administration of oxygen via humidified high-flow nasal cannula (HFNC), has become prevalent during bronchiolitis hospitalization outside of the intensive care unit despite absence of evidence demonstrating benefit in bronchiolitis.

Problematically, in addition to lack of demonstrated benefit, HFNC has been associated with longer length of stay and, independent of length of stay (which drives cost of hospitalization), higher cost associated with its use, as it is estimated to be 16 times more costly to use. Recent descriptive work has demonstrated a striking range in HFNC across hospitals: a hallmark of discretionary or preference-based use and likely overuse.

Despite the growing evidence highlighting its limited use outside of the critical care setting and concerns about cost and length of stay, there is no accepted standards for when HFNC is appropriate. Quality improvement and deimplementation work is necessary to address this practice variation and potentially unnecessary use; however, future work is limited without any agreed-upon practice standards for appropriate HFNC use.

Description – Cincinnati Children’s is recruiting 1 – 2 individuals with relevant expertise in clinical medicine and/or research to serve on a national expert panel. This panel will work to develop evidence-driven consensus recommendations for appropriate high-flow nasal cannula use in hospitalized pediatric patients with bronchiolitis. This work is being conducted under the auspices of Cincinnati Children’s Hospital Medical Center and Children’s Hospital of Philadelphia.

Those who are interested in this opportunity should be expert clinicians with deep practical caring for hospitalized children, including children with bronchiolitis and/or relevant scholarly expertise. Interested individuals should be capable of providing input on a broad variety of clinical circumstances, able and willing to work with a multidisciplinary panel, and able to represent the concerns and priorities of SPN. Though not required, distinguishing characteristics include experience in research, quality improvement, or literature review related to the use of respiratory support, including high-flow nasal cannula, in bronchiolitis. Final selections will be based on the expertise required to meet the specific needs of the Panel, and every effort will be made to ensure appropriate balance of membership.