Clinical Interventions During Inter-hospital Transfer of Infants With Moderate-to-Severe Bronchiolitis: Implications for Advanced Nursing Practice.
Arthur Gaudaire, Christophe Milesi, Alexia Morel and 7 others
PMID 41867162WHAT IT FOUND
Three simple thresholds at the regulation call identify which infants need a doctor on the transport team: HFNC with FiO2 over 40%, CPAP with FiO2 over 35%, or pCO2 over 65 mmHg.
Applying these criteria would have allowed 70% of transfers to be safely managed by nurse-led teams.
Key findings
01Combining three criteria at the regulation call (HFNC FiO2 > 40%, CPAP FiO2 > 35%, or pCO2 > 65 mmHg) yielded a sensitivity of 90%, specificity of 78% and negative predictive value of 98% for predicting clinical intervention.
02A complete medical team was mobilised in 95% of transports, yet clinical interventions requiring physician presence occurred in only 12% of cases.
03Infants who required intervention had higher FiO2 (51.3% ± 19.3% vs. 34.8% ± 10.2%; p < 0.01), lower pH (7.30 ± 0.08 vs. 7.34 ± 0.07; p = 0.03) and higher pCO2 (62.9 ± 17.9 vs. 49.6 ± 11.2 mmHg; p = 0.01).
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
Retrospective design led to missing data, notably regarding the mWCAS score, which was documented in only 28% of cases. Single-centre study, so results may not be generalisable to other regions where paediatric emergency transport and nursing expertise differ. The definition of 'clinical intervention' was based on pragmatic criteria and excluded some upgrades in respiratory support that are permitted within nursing competence. Data were collected during a period marked by a major RSV epidemic and the introduction of preventive strategies, which may affect future transport needs. Data on race or ethnicity were not available.
Declared interests
The authors declare no conflicts of interest. The work was supported by the Montpellier University Hospital, France.
The easy way to misread this
Do not assume that nurse-led transfer is universally safe for all infants with moderate-to-severe bronchiolitis. Safety was demonstrated only when specific respiratory and blood gas thresholds (HFNC FiO2 > 40%, CPAP FiO2 > 35%, pCO2 > 65 mmHg) were not exceeded, and relies on advanced paediatric critical care nurses with specific training and certification in non-invasive respiratory support.