Skip to main content
UCSF Health

Appendix 3: High Flow Holiday for Patients with Bronchiolitis on HHFNC

Who This Pathway Applies To

  • Patients with bronchiolitis on HFNC who are 30 days of age or older.

Step 1: Assess for High Flow Holiday Readiness

  • Assess every 4 hours for clinical improvement and High Flow Holiday readiness.
  • Wean FiO2 to maintain the goal oxygen saturation.
  • Optimize suctioning and hydration.
  • Continue current weaning practices.

Step 2: Check Readiness Criteria

Determine whether both of the following are true:

  • SpO2 is 90% or higher on FiO2 of 40% or less.
  • Heart rate is within normal limits for age when the patient is calm.

If no: Continue routine care on HFNC and reassess every 4 hours for High Flow Holiday readiness.

If yes: Begin the High Flow Holiday.

Step 3: High Flow Holiday

  • From any flow rate, turn off HFNC and remove the cannula from the nose.
  • Monitor at the bedside for 5 to 15 minutes.
  • Perform the High Flow Holiday at least twice a day.

Other Options

  • If flow is greater than 10 L, consider decreasing flow by 50% and placing the patient on room air with the next High Flow Holiday.
  • If the HFNC machine permits, consider a trial of 1 to 2 L at 100%.

Step 4: Reassess

  • Reassess within 30 to 60 minutes to evaluate the High Flow Holiday outcome.

Step 5: Determine the Outcome

No Pass

Use this outcome if there is clinical decompensation, severe work of breathing, and increased heart rate and/or respiratory rate.

  • Return to the previous HFNC settings.
  • Continue weaning efforts.
  • Assess readiness for the next High Flow Holiday.

Pass to Low-Flow Nasal Cannula (LFNC)

Use this outcome if heart rate, respiratory rate, and work of breathing are acceptable, but SpO2 is below 90%.

  • Place the patient on low-flow nasal cannula.
  • Continue weaning efforts.

Pass to Room Air (RA)

Use this outcome if heart rate, respiratory rate, and work of breathing are acceptable and SpO2 is 90% or higher.

  • Maintain the patient on room air with attention to suctioning and hydration.