Letter to the Editor

We read with great interest the recent publication on the use of nasal high-flow (NHF) therapy in infants with bronchiolitis.¹ The study provides valuable insights into the clinical decision-making and outcomes associated with NHF versus standard oxygen therapy.

While the discussion addresses many aspects of the findings, one specific point requires further clarification. Given the significantly higher rate of paediatric intensive care unit (PICU) admissions for infants receiving NHF despite similar disease severity, we would like to ask the authors:

Did the authors examine each participating hospital's local protocols to evaluate whether variations in institutional practices and escalation protocols correlated with the higher PICU admission rates for infants on NHF? Were there differences in the use of standardised state-wide versus individual hospital-based escalation tools or variations in bronchiolitis management protocols?

Understanding these variations in more detail could provide valuable insights for standardising NHF use across hospitals with and without onsite PICUs and potentially reducing unnecessary PICU admissions.

Thank you for considering these questions.