Increasing RSV PICU admissions after large-scale introduction of high flow nasal cannula

Linssen RS, Bem RA, Kapitein B, Rengerink KO, Otten MH, den Hollander B, Bont L, van Woensel JBM

High flow oxygen intends to decrease work of breathing and prevent respiratory failure. Despite trials have shown benefit, high flow oxygen has not brought the success hoped for as it did not decrease the need for PICU admissions. This study studied trends in 15,606 pediatric intensive care unit (PICU) admissions for (RSV) bronchiolitis in The Netherlands, France, Scotland, Belgium, Italy and Norway between 2000 and 2019. The authors observed an increase in the annual number of RSV-PICU admissions, as well as in the proportion of RSV-PICU admissions compared to all PICU admissions and the national population-based estimates per 100,000 children. The proportion of children with a risk factor for severe RSV bronchiolitis remained the same and the proportion of intubated children online moderately declined. The authors relate their findings to the widespread introduction of high-flow nasal cannula (HFNC) in the PICU that started around 2009. The increasing PICU burden by RSV bronchiolitis related to high flow oxygen support warrants further attention. 

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