Bronchiolitis is the leading cause of hospital admissions for infants in the United States. 15-25% of these patients are admitted to the pediatric intensive care unit (PICU), where 25-40% require intubation and invasive mechanical ventilation (IMV). IMV carries substantial risk of complications including vocal cord dysfunction, ventilator-induced lung injury and infection. Methods of respiratory support such as noninvasive positive pressure ventilation (NPPV) with continuous positive airway pressure (CPAP) or bilevel positive airway pressure (BIPAP) and high-flow nasal cannula (HFNC) have been shown to reduce eventual conversion to IMV. It is unclear, however, whether there is an initial modality of airway support that reduces risk of eventual IMV use.
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