Noninvasive Ventilation in Pediatric Bronchiolitis: Variables Related to Weaning Readiness and Approach

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Abstract
Background: There is a lack of evidence related to weaning noninvasive ventilation in bronchiolitis. The purpose of this study was to identify variables related to NIV weaning readiness and approach in bronchiolitis. Methods: A retrospective cohort study of 74 children less than two years of age with bronchiolitis, requiring NIV and admitted to a pediatric intensive care unit (PICU) from 2022 to 2023. Demographic variables, clinical metrics, NIV mode, and weaning metrics were collected. Results: Mean total duration of NIV therapy was 40 h with weans lasting 13 h. Duration for children on CPAP alone was shorter (26 h) than for children on combination of BiPAP and CPAP (45 h, 95% CI 4.258 to 33.742, p = 0.0123). Wean times were also shorter for children on CPAP alone (mean 5 h) than children on BiPAP and CPAP (mean 16 h) (95% CI 1.899 to 20.101, p = 0.0185). Patients were more likely to have a “complex wean,” defined as escalation and de‐escalation between multiple settings, with BiPAP (44.6%) than with CPAP (18.8%). RR at first wean was a significant predictor of NIV weaning duration ( p = 0.007). Conclusion: There is a need for NIV weaning guidelines. RR may be an important predictor of NIV weaning readiness and approach. A “complex wean” may be a potential outcome variable for weaning NIV in children with bronchiolitis. This study may be used to inform future research and guidelines for weaning NIV in children with bronchiolitis.

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