The starting rate for high‐flow nasal cannula oxygen therapy in infants with bronchiolitis: Is clinical judgment enough?

Objectives To determine whether in infants with bronchiolitis admitted to a pediatric intensive care unit (PICU) the starting rate for high‐flow nasal cannula (HFNC) therapy set by the attending physicians upon clinical judgment meets patients' peak inspiratory flow (PIF) demands and how it influences respiratory mechanics and breathing effort. Methodology We simultaneously obtained respiratory flow and esophageal pressure data from 31 young infants with moderate‐to‐severe bronchiolitis before and after setting the HFNC rate at 1 L/kg/min (HFNC‐1), 2 L/kg/min (HFNC‐2) or upon clinical judgment and compared data for PIF, respiratory mechanics, and breathing effort. Results Before HFNC oxygen therapy started, 16 (65%) infants had a PIF less than 1 L/kg/min (normal‐PIF) and 15 (45%) had a PIF more than or equal to 1 L/kg/min (high‐PIF). Normal‐PIF‐infants had higher airway resistance (p