Hypoxemia is a frequent complication during bronchoscopy, and optimal oxygenation strategies remain clinically important. Previous evidence suggests that high-flow nasal cannula (HFNC) may outperform conventional oxygen therapy (COT). A meta-analysis of randomized controlled trials (RCTs) was conducted by searching PubMed, Embase, and Cochrane databases for studies comparing HFNC with COT in adult patients undergoing flexible bronchoscopy. Outcomes included the incidence of hypoxemia, lowest SpO2, procedure duration, patient comfort, and sedation dose. Pooled data were analyzed using a random-effects model, with results reported as risk ratios (RR), mean differences (MD), or standardized mean differences (SMD), as appropriate. Heterogeneity was assessed using the Cochran Q test and I2 statistic. Fourteen RCTs (n=2480) were included: 1263 patients (50.9%) received HFNC. HFNC significantly reduced the risk of hypoxemia (RR, 0.41; 95% CI: 0.29-0.59; P<0.0001) and increased minimum SpO2 (MD, +5.10 percentage points; 95% CI: 3.30-6.91; P<0.0001). There was no significant difference in patient comfort (SMD, -0.07; 95% CI: -0.25 to 0.11; P=0.46) and procedure time (MD, -0.73min; 95% CI: -1.73 to 0.27; P=0.154). Sedation requirements were slightly higher in the HFNC group (SMD, 0.17; 95% CI: 0.04-0.29; P=0.008). HFNC significantly reduces hypoxemic events and improves oxygenation compared with COT during bronchoscopy. Although anesthetic use slightly increased, there was no difference in procedure time or patient comfort.

Biological subphenotypes in severe acute hypoxaemic respiratory failure and acute respiratory distress syndrome using rapid prospective classification (SPARC) in the USA: a multicentre, observational, study.

Although the use of high-flow nasal cannula (HFNC) is recommended for the management of acute hypoxemic respiratory failure and for postextubation respiratory support, the efficacy for other etiologies remains uncertain. This study aimed to examine temporal trends in HFNC utilization and describe variations in clinical practice and clinical course across diverse disease categories and care settings. We conducted a retrospective cohort study using a nationwide in-patient database in Japan. Hospitalized subjects who received HFNC between April 2016 and March 2023 were included. Temporal trends in HFNC use were evaluated by fiscal year using the Cochran-Armitage test. Subjectcharacteristics, disease categories, treatment location at HFNC initiation (ICU, high-dependency unit, or general ward), timing of HFNC initiation, use of invasive mechanical ventilation, and in-hospital mortality were analyzed descriptively. A total of 277,279 subjects received HFNC during the study period. The annual rate of HFNC use per 1,000 admissions increased from 2.0 in 2016 to 8 in 2022 (P < .001). Respiratory diseases were the most common indication (37%), followed by cardiovascular diseases (23%), neonatal conditions (17%), and malignancy (10%). HFNC was frequently used in conjunction with invasive mechanical ventilation, particularly after extubation, among subjects with cardiovascular conditions and neonatal subjects. In contrast, HFNC was more often used without invasive mechanical ventilation in subjects with respiratory diseases or malignancy, frequently in general wards. Overall in-hospital mortality was 25% and varied markedly by disease category and care setting, with particularly high mortality among subjects with interstitial pneumonia or malignancy who initiated HFNC in general wards, approaching 60%. HFNC use increased markedly in Japan and expanded beyond ICUs into general wards. Utilization patterns and outcomes differed considerably by underlying disease and care setting, indicating heterogeneous clinical roles of HFNC across patient populations.

Acute hypoxemic and hypercapnic respiratory failure are among the most common reasons for ICU admission and need for invasive mechanical ventilation. Noninvasive respiratory support (NIRS) strategies-including high-flow nasal cannula (HFNC), noninvasive ventilation (NIV), and continuous positive airway pressure (CPAP)-may prevent intubation, improve outcomes, and reduce ICU utilization. However, there is uncertainty regarding optimal patient and modality selection, resulting in variable implementation. There are no clinical practice guidelines comprehensively addressing the use of the different noninvasive respiratory support strategies across the spectrum of acute respiratory failure. To update and develop new evidence-based clinical practice recommendations informing noninvasive respiratory support use, including HFNC, NIV and CPAP, in adults with acute respiratory failure. A multidisciplinary panel used the GRADE approach to address four PICO questions related to the use of NIRS for hypoxemic and hypercapnic respiratory failure, preoxygenation for intubation, and post-extubation respiratory support. Recommendations were informed by several systematic reviews and network meta-analyses. The panel made a strong recommendation for HFNC and a conditional recommendation for NIV or CPAP for adults with acute hypoxemic respiratory failure with close monitoring for the need for escalation of respiratory support, based primarily on effects on need for intubation. For acute hypercapnic respiratory failure, the panel made a strong recommendation for NIV to reduce mortality and need for invasive mechanical ventilation, and a conditional recommendation for HFNC only in patients with less severe hypercapnia and with mild acidemia (eg, pH > 7.25), provided that close monitoring and prompt escalation to NIV are available. The panel made a strong recommendation for HFNC or NIV for preoxygenation prior to endotracheal intubation to prevent peri-intubation hypoxemia. The panel also issued a risk-based recommendation, suggesting HFNC for low-risk patients and NIV for high-risk patients to reduce the need for re-intubation following extubation after critical illness. Noninvasive respiratory support strategies are effective in improving outcomes in a range of clinical scenarios. We provide evidence-based recommendations, which can be further informed by patient risk, institutional capacity, and interface tolerance.

IntroductionDyspnea is a prevalent, debilitating, and distressing symptom in palliative care. This systematic review evaluated the efficacy of oxygen therapy and oxygen delivery modalities compared with room air, medical air (FiO2 21%), pharmacological therapy, or other respiratory support modalities for relieving dyspnea in patients with advanced, progressive, and incurable diseases.MethodsA systematic search of PubMed and Scopus was conducted for studies published up to February 15, 2026, evaluating oxygen therapy or oxygen delivery modalities for dyspnea in palliative care. Risk of bias was assessed using the Cochrane RoB 2 tool and the Newcastle-Ottawa Scale. Data synthesis was performed narratively.ResultsNine studies encompassing 879 participants were included. Among seven clinical trials, only one presented a low overall risk of bias. In non-hypoxemic patients, oxygen therapy was not consistently superior to medical air. In hypoxemic patients, limited evidence suggested benefit from conventional oxygen compared with room air, while high-flow nasal cannula was associated with greater short-term dyspnea relief than conventional oxygen therapy in one emergency department trial. Opioid therapy was associated with greater dyspnea reduction than oxygen alone in one prospective study.ConclusionOxygen therapy should not be prescribed routinely for dyspnea in non-hypoxemic palliative care patients. Its use should be guided by baseline oxygenation status, delivery modality, expected symptomatic benefit, patient goals, and treatment burden. The certainty of evidence remains limited by small samples, heterogeneity, and risk of bias.

Objective: Heated high flow nasal cannula (HHFNC) use in pediatric critical asthma is rising despite concerns regarding its ability to effectively deliver nebulized medications to the lower airway. We aim to measure the association of low versus high HHFNC flow rates for delivery of continuously inhaled short acting beta agonist (cSABA) on clinical outcomes in the Pediatric Intensive Care Unit (PICU).Methods: This is a retrospective cohort study investigating PICU patients admitted with critical asthma who were prescribed HHFNC for cSABA delivery. Patients were divided into two groups based on the average flow rate used to deliver cSABA: low flow (≤5 L/min) versus high flow (>5 L/min). Outcomes including total duration of cSABA, total duration of noninvasive respiratory support (HHFNC, continuous (CPAP) and bilevel (BPAP) positive airway pressure), PICU LOS, and hospital LOS were explored. Data were analyzed by Wilcoxon-Rank Sum, Chi-squared and Fisher's Exact tests.Results: 112 patients were included. Patients in the low flow group (n = 56) had a median HHFNC flow rate of 4.0 L/min (IQR 3.9-4.0) versus patients in the high flow group (n = 56) at 9.6 L/min (IQR 7.0-15.0; p < 0.001). Pediatric Asthma Severity Scores (PASS) were similar (p = 0.095). The low flow group had significantly shorter total duration of cSABA (p = 0.048), shorter duration of noninvasive respiratory support (p = 0.0234), and shorter PICU (p < 0.001) and hospital (p = 0.0063) LOS.Conclusions: Low HHFNC flow rates for cSABA delivery are associated with shorter durations of cSABA, noninvasive respiratory support, PICU and hospital LOS.

Persistent air leaks (PALs), defined as air leaks lasting more than 5-7 days, are a challenging complication of pneumothorax that prolong hospitalization and increase infection risk, especially in patients unfit for surgery. Autologous blood patch pleurodesis (ABPP) is a simple, safe, and cost-effective alternative. We report a young man in his 20 s with disseminated tuberculosis, with pulmonary, pleural, CNS and ocular involvement, presented with bilateral spontaneous pneumothorax. He required high-flow nasal oxygen and bilateral intercostal drainage (ICD). Despite initial management and negative suction, persistent bilateral air leaks were noted on imaging. ABPP was performed on left side using 80 mL (2 mL/kg) of autologous blood instilled via ICD, followed by saline flush, tube elevation, and supine positioning. Serial chest radiographs at 4, 24, and 48 hours showed complete resolution of the left-sided pneumothorax, while the right side improved with negative suction. Both ICDs were subsequently removed, and patient was discharged on antitubercular therapy and steroids, with no recurrence on follow-up. ABPP, first described in 1987, has reported success rates exceeding 90%, with proposed mechanisms including pleurodesis through inflammation and mechanical sealing of leaks by clot formation. Compared to chemical pleurodesis, ABPP is less invasive, inexpensive, and associated with fewer adverse effects, including less pain and fever, with shorter hospital stay. This case highlights ABPP as an effective and practical option for managing refractory pneumothorax with persistent air leak.

For pediatric patients with congenital heart disease (CHD) and pulmonary arterial hypertension (PAH), corrective repair carries a substantial risk of inducing pulmonary hypertensive crisis (PHC). The conventional clinical strategy involves postoperative administration of inhaled nitric oxide (iNO) followed by a gradual tapering process, which is often associated with prolonged postoperative recovery. To address this limitation, this study proposes a fast-weaning strategy: the continuation of iNO delivery via high-flow nasal cannula (HFNC) following extubation. This single-center, retrospective cohort study screened pediatric patients with systemic-to-pulmonary artery shunt type CHD and a pulmonary vascular resistance index (PVRi) > 6 WU × m2 between 2019 and 2024. Eligible patients admitted from 2023 to 2024 were assigned to Group 1 (fast-weaning), while those admitted from 2019 to 2022 constituted Group 2 (standard-weaning). For propensity-score matching, the predictive variables included age, preoperative PVRi, and the duration of cardiopulmonary bypass. Following propensity score matching, 22 matched pairs were included in the final analysis. Pulmonary hypertensive crisis recurrence occurred in two of 22 patients (9.1%) in Group 1 and three of 22 patients (13.6%) in Group 2 (p > 0.99). Patients in Group 1 had a significantly shorter duration of mechanical ventilation (18 [8.5, 22.3]) versus 21.5 (19.8, 27.3) hours; p = 0.014) and postoperative intensive care unit length of stay (2 [1, 4]) versus 3 [3, 5] days; p = 0.023). No major postoperative complications were reported in either group. Continuing iNO via HFNC following extubation is a safe weaning strategy. It may be associated with faster recovery, providing a potential alternative to conventional protocols.

Selecting the appropriate mode of respiratory support in cases of acute respiratory failure is clinically challenging and has relevant implications for patient outcomes. Despite the widespread use of noninvasive techniques, uncertainties remain regarding optimal indications, timing of escalation and patient-centered aspects. This paper summarizes the chapter on interpretation of indications and alternatives to invasive mechanical ventilation from the German S3 clinical guidelines "invasive ventilation and extracorporeal life support in acute respiratory failure". For the guideline revision asystematic literature search and critical appraisal were conducted, including national and international guidelines. Recommendations were developed using the evidence to decision framework and a consensus was reached in several conferences. Noninvasive respiratory support, including noninvasive ventilation (NIV) and high-flow nasal oxygen (HFNO), is effective in patients with moderate impairment of oxygenation (PaO2/FiO2 100-300 mm Hg) and can avoid endotracheal intubation but requires close clinical monitoring. In patients with severe respiratory failure (PaO2/FiO2 < 100 mm Hg) or treatment failure under noninvasive respiratory support, invasive ventilation is required. Further recommendations concern specific patient groups. The available evidence supports an individualized approach to the choice of respiratory support that incorporates patients' preferences. Key elements include a regular reassessment, avoidance of delayed intubation, adequate personnel and expert resources and transparent communication within the interdisciplinary treatment team.

Respiratory syncytial virus outcomes and duration of protection following nirsevimab administration in high-risk infants: a real-world study under year-round epidemic circulation in Japan.

The benefits of non-invasive respiratory support strategies (NIRS), such as high-flow nasal oxygen therapy, in delaying intubation remain uncertain. We used an emulated target trial approach to evaluate outcomes associated with late intubation in patients with severe acute respiratory failure due to COVID-19. We conducted a retrospective multicentre cohort study using the French prospective OUTCOMEREA database. Adult patients admitted to intensive care units (ICUs) for severe SARS-CoV-2 pneumonia with an ICU length of stay of at least seven days were included in the study. Descriptive analyses were used to compare patients who were intubated after day 6 with those who remained under NIRS. In the emulated target trial, patients who were eligible between ICU days 7 and 12 were assigned to undergo late intubation or to remain under NIRS. Weighted Cox proportional hazards models were used. The primary outcome was 60-day mortality. Of the 1206 ICU patients with SARS-CoV-2 pneumonia, 288 were still in the ICU on day 7. Of these, 65 (22.6%) subsequently underwent late intubation and had a 60-day mortality rate of 78.5%. In the emulated target trial, which included 234 patients at risk of intubation, 57 underwent late intubation. Late intubation was associated with a higher risk of death (adjusted hazard ratio: 2.89; 95% confidence interval: 1.50-3.92). The estimated absolute difference in 60-day survival was - 0.34 (95% CI - 0.62 to 0.30). The restricted mean survival time was 17.8days shorter in the late intubation group (95% CI - 30.6 to 10.8). In this multicentre cohort, patients requiring late intubation had a very high mortality rate. In the emulated target trial analysis, late intubation was associated with poorer survival compared to continued NIRS, suggesting a subgroup of patients with progressive respiratory failure rather than a direct effect of intubation timing.

Aerosol therapy is an essential procedure in the treatment of acute and chronic respiratory diseases. Currently, there are no up-to-date guidelines from German-speaking countries on the selection and use of nebulizer systems in patients undergoing high-flow therapy via nasal cannula (HFT) and non-invasive ventilation (NIV). An interdisciplinary panel of experts consisting of pulmonologists and intensive care physicians developed practice-oriented recommendations for aerosol therapy under HFT and NIV. The evidence base was derived from a systematic search of the PubMed database of the US National Library of Medicine up to and including November 2025.Publications on clinical studies, reviews, guideline documents, and technical reports were included. The respective level of evidence of the information was evaluated. The recommendations were agreed upon in a multi-stage process. Aerosol administration under HFT and NIV with a vibrating mesh nebulizer (VMN) achieved better lung deposition compared to the use of a jet nebulizer (JN). A JN is suitable if VMNs are not available, if highly viscous drug solutions are to be nebulized, or if there are budgetary limitations. The choice and application of the nebulizer system should be patient-specific, consistent with the indication, taking into account technical, clinical, and economic requirements.

Patients with obstructive lung diseases are vulnerable to dynamic hyperinflation and increased work of breathing (WOB). Although ventilator circuit components influence respiratory mechanics, the impact of the expiratory port design on WOB has received limited attention. This study examined whether exhalation resistance measurements can predict expiratory pressure-volume area (PVA) in an obstructive lung disease model. Four expiratory ports were tested Intersurgical (IS), Philips (P), ResMed (RM), and HSINER (H). Exhalation resistance, end-expiratory pressure, and expiratory PVA were measured using a PF-301 flow analyzer. Exhalation resistance was measured using a high-flow nasal cannula at 30, 40, 50, and 60 L/min. An obstructive lung model was created using a test lung in pressure control mode (PEEP 5 cm H2O). Statistical analyses included two-way analysis of variance (ANOVA) for exhalation resistance and one-way ANOVA with Tukey-Kramer post hoc tests for end-expiratory pressure and PVA. The P port exhibited the lowest exhalation resistance (0.343 cm H2O/L/s) but the highest PVA (0.013 ± 0.001 J/L) and end-expiratory pressure (0.134 ± 0.007 cm H2O), significantly exceeding those of all other ports. The IS port demonstrated the highest exhalation resistance (0.37 cm H2O/L/s) but intermediate PVA (0.004 ± 0.004 J/L). The H port demonstrated PVA below 0.001 J/L, and the RM port showed 0.001 ± 0.001 J/L. No significant correlation was observed between exhalation resistance and PVA (r = -0.892, R2 = 0.796, P = .11). Exhalation resistance measurements did not predict respiratory mechanical burden in this obstructive lung disease model. Despite exhibiting the lowest exhalation resistance, the P port generated the highest PVA and an end-expiratory pressure elevation of 0.14 cm H2O above set PEEP. Expiratory port characteristics beyond exhalation resistance, including structural features affecting pressure dynamics, should be evaluated to optimize circuit configuration for patients with obstructive lung disease who are vulnerable to dynamic hyperinflation.

High flow nasal oxygen for acute hypoxaemic respiratory failure in the intensive care unit: An umbrella review.

Prone positioning has been shown to improve respiratory mechanics and oxygenation, but its clinical benefit in infants with acute viral bronchiolitis receiving high-flow nasal cannula (HFNC) support remains unknown. To investigate whether prone positioning in infants with moderate to severe acute bronchiolitis and HFNC support reduces escalation to noninvasive or invasive ventilation. Multicenter, randomized, open-label trial conducted in 15 pediatric intermediate or intensive care units in France. Infants aged 6 months or younger admitted for 24 hours or less with a diagnosis of acute bronchiolitis with moderate to severe respiratory distress requiring HFNC support were enrolled between January 2021 and November 2023 and followed up until hospital discharge (last patient discharged on December 11, 2023). Participants were randomly assigned to the prone position (n = 221) or supine position (n = 230). Infants in the prone position group received prone positioning for 24 hours or longer during the first 48 hours. All participants received standardized HFNC support at 2 L/kg/min. The primary outcome was the need for escalation of care to noninvasive or invasive ventilation within the first 72 hours, according to prespecified criteria. Secondary outcomes included treatment failure, determined by an independent clinical adjudication committee; tolerance of prone positioning; length of hospital stay; duration of respiratory support; infant comfort; and adverse events. Among 451 infants randomized, 446 were included in the primary analysis (median age, 41 [IQR, 19-72] days; 54% male). Escalation of care occurred in 80 infants (17.9%), with no significant difference between the prone position (33/220 [15.0%]) and supine position (47/226 [20.8%]) groups (adjusted odds ratio, 0.66 [95% CI, 0.40-1.07]; P = .09). Secondary outcomes did not differ significantly between the 2 groups. In the safety analysis, serious adverse events occurred in 2 of 180 infants (1.1%) in the prone position group and 2 of 264 (0.8%) in the supine position group. Prone positioning in infants with moderate to severe bronchiolitis receiving HFNC support did not significantly reduce escalation of care. However, the wide 95% confidence interval around the observed odds ratio suggests that this study was not definitive and further research is warranted. ClinicalTrials.gov Identifier: NCT03976895.

In high-altitude environments with hypobaric hypoxia, chronic hypoxia can affect organs. This study aimed to determine whether high-flow nasal oxygen (HFNO) can reduce the incidence of hypoxemia in elderly patients undergoing gastroscopy with sedation at high altitudes. This single-center, partially-blinded, prospective randomized trial was conducted in Shigatse, Tibet, China (3800m above sea level). Elderly patients aged ≥ 60 undergoing gastroscopy with sedation were randomly assigned to either the HFNO group (60L per minute, 100% oxygen) or the conventional nasal cannula (CNC) group (6L per minute). The primary endpoint was the incidence of hypoxemia, defined as pulse SpO2 < 90% for > 10s during sedation. The incidence of hypoxemia was significantly lower in the HFNO group than the CNC group (2.8% vs. 32.9%, risk ratio (RR): 0.691; 95% confidence interval (CI): 0.584-0.818, p < 0.001). The median SpO2 after pre-oxygenation was similar between the groups (97.0% [96.0-98.0] vs. 96.0% [95.0-98.0], p = 0.053). However, the median minimum SpO2 during the procedure was significantly higher in the HFNO group compared to the CNC group (96% [95-98] vs. 93% [87-96], p < 0.001). The median duration of hypoxemia and the number of hypoxemia episodes were 0.0s (0.0-22.0) and 0 (0-1), respectively. In contrast, the values were 0.0s (0.0-0.0) and 0 (0-0) in the HFNO group (p < 0.001). The median recovery time was shorter in the HFNO group compared to the CNC group (1.0min [0.5-1.5] vs. 1.5min [1.0-2.5], p = 0.003). Compared to CNC, HFNO significantly reduced the incidence of hypoxemia during gastroscopy with sedation in elderly patients at high altitudes. ChiCTR2400085110; registered on 31 May 2024.

Non-invasive continuous positive airway pressure (CPAP) is the standard initial respiratory support for preterm infants. However, requirements such as optimal pressure delivery and facemask repositioning, which trigger unwanted reflexes and bradycardia, often necessitate the use of positive pressure ventilation (PPV). Findings from a pilot study suggested that high-flow nasal cannula (HFNC) may be a promising alternative to CPAP, with lower PPV requirements. We hypothesize that HFNC is a safe, effective, and user-friendly alternative to CPAP for stabilizing very preterm infants (28 + 0-31 + 6weeks of gestation), potentially reducing the need for PPV. We aim to compare HFNC and CPAP as initial respiratory support strategies at birth. This is a multicenter, randomized, stepped-wedge cluster trial. Infants will receive either HFNC (8 L/min) or CPAP (6 cmH2O) immediately after birth with tactile stimulation. The fraction of inspired oxygen (FiO2) will start at 0.30. PPV will be initiated if bradycardia or persistently low oxygen saturation (SpO2) occurs. The primary outcome is stabilization with the assigned support without PPV administration. Secondary outcomes include (A) achievement of SpO2 ≥ 80% at 5min (with ≤ 2 brief PPV episodes) as a surrogate of safety and (B) achievement of SpO2 > 90% with FiO2 ≤ 0.40 at 10min as a surrogate of efficacy. Overall, 446 infants will be recruited in both arms, with an estimated study duration of 2years. The findings may inform future respiratory support guidelines for very preterm infants at birth. ClinicalTrials.gov NCT06543589. Registered on August 9, 2024.

High-flow nasal cannula (HFNC) is commonly used for acute hypoxemic respiratory failure and for subjects at risk of postextubation failure. HFNC reduces inspiratory work, but its effects on expiratory muscle activity, including the abdominal wall muscles, are uncertain. We tested whether HFNC decreases expiratory effort in a flow-dependent manner. In this single-center, randomized, crossover trial, we enrolled 30 ICU subjects requiring HFNC. After baseline low-flow oxygen, subjects received HFNC at 30, 40, and 50 L/min in random order for 15 min each. We quantified expiratory muscle activity by ultrasound-derived thickening fractions of the lateral abdominal muscles (TFABD; external oblique + internal oblique + transversus abdominis) and rectus abdominis (TFRA). We also recorded diaphragm thickening fraction (DTF) and hemodynamic variables. Overall, HFNC did not change TFABD, TFRA, or respiratory and hemodynamic variables versus baseline. DTF decreased at 50 L/min (mean 13% vs 25% at baseline; P = .042). In exploratory analyses, subjects with higher baseline expiratory activity (TFABD > 10%) showed reduced TFABD at 40 and 50 L/min, whereas those with baseline TFABD ≤ 10% did not. Baseline TFABD correlated inversely with flow-related changes at all flows (eg, r = -0.867 at 40 L/min; P < .001). HFNC did not uniformly reduce expiratory muscle activity in this relatively stable ICU cohort. Subjects with higher baseline expiratory activity showed abdominal muscle unloading at higher flows. Bedside abdominal ultrasound may help identify subjects more likely to benefit from higher HFNC flow settings.

Crossover to Noninvasive Ventilation After High-Flow Nasal Cannula Failure: Insights From the RENOVATE Trial.

High-flow nasal cannula (HFNC) and continuous positive airway pressure (CPAP) are options for respiratory support in infants with bronchiolitis. The aim of this study was to evaluate the use of HFNC and CPAP in infants with bronchiolitis at five hospitals in Norway to study time trends over seasons and differences in use between hospitals. In this multicentre retrospective study, we compared data from 1186 infants < 12 months of age hospitalized for bronchiolitis at five Norwegian hospitals during the winter seasons 2017-2018, 2018-2019, and 2021-2022. Over the three seasons, HFNC was provided to 29%-33% and CPAP to 8%-18% of all infants, but with a substantial difference between hospitals for both modalities. The change between seasons was less prominent but also differed between hospitals. The length of stay was longer, and the age and weight were lower in those receiving any non-invasive respiratory support, but this did not differ between infants treated with HFNC or CPAP. In Norwegian hospitals there was a substantial variation in the use of HFNC and CPAP for infants with bronchiolitis. This calls for unified and evidence-based guidelines for the use of non-invasive respiratory support for this patient group.