# Clinical Interventions During Inter‐hospital Transfer of Infants With Moderate‐to‐Severe Bronchiolitis: Implications for Advanced Nursing Practice

## TL;DR

This study identifies specific oxygen and blood gas thresholds to determine if nurse-led teams can safely transport infants with severe bronchiolitis without a doctor.

## Contribution

The paper introduces evidence-based thresholds for FiO2 and pCO2 to guide triage decisions for nurse-led transport teams.

## Key findings

- Higher FiO2, lower pH, and higher pCO2 levels were associated with the need for clinical intervention during transport.
- FiO2 > 40% on HFNC or pCO2 > 65 mmHg predicted the need for a medicalised team with high accuracy.
- Most transfers can be safely managed by nurse-led teams when these thresholds are not exceeded.

## Abstract

Bronchiolitis is a leading cause of hospitalisation and paediatric intensive care admissions in infants. Moderate‐to‐severe cases often require inter‐hospital transfer for respiratory support, usually organised by specialised paediatric emergency transport services (PETS). The optimal composition of transport teams, whether nurse‐led or medicalised, remains uncertain.

To identify predictive factors available during the regulation call that can help determine when an inter‐hospital transfer of infants with moderate‐to‐severe bronchiolitis can be safely conducted by a nurse‐led team without a paediatrician, by predicting the need for clinical intervention during transport.

A retrospective observational study was conducted from 2021 to 2023 within the PETS of a French University Hospital. Infants under 2 years transferred for moderate‐to‐severe bronchiolitis were included. The primary outcome was the occurrence of a clinical intervention during transport, defined as any event requiring physician‐level management: apnoea requiring manual ventilation, fluid bolus, initiation of two‐level non‐invasive ventilation or endotracheal intubation. Clinical and paraclinical parameters available at the regulation call—particularly ventilatory support mode, FiO2 and blood gas values—were analysed for their ability to predict the occurrence of such interventions using receiver operating characteristic (ROC) analysis.

Among 167 included infants (mean age 157 ± 169 days; weight 5.9 ± 2.7 kg), 20 (12%) required a clinical intervention. 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) were associated with interventions. The presence of high‐flow nasal cannula (HFNC) with FiO2 > 40%, or continuous positive airway pressure (CPAP) with FiO2 > 35% or pCO2 > 65 mmHg predicted the need for a medicalised team (AUC = 0.83; sensitivity 90%, specificity 78%, negative predictive value 98%).

Most inter‐hospital transfers of infants with moderate‐to‐severe bronchiolitis can be safely undertaken by nurse‐led teams when predefined respiratory or blood gas thresholds are not exceeded.

This study provides objective criteria to guide decision‐making regarding team composition during the regulation of inter‐hospital transfers for infants with moderate‐to‐severe bronchiolitis. FiO2 and pCO2 thresholds measured at the initial call can help identify cases requiring physician presence, while allowing most transfers to be safely conducted by nurse‐led teams. These results support the development of standardised triage protocols and strengthen the role of advanced paediatric critical care nurses in retrieval medicine. Integrating such evidence‐based criteria into practice could optimise human resources, maintain safety and improve response times in paediatric emergency transport systems.

What is known about the topic
○Bronchiolitis is a major cause of PICU transfer in infants.○Team composition during transport (nurse‐led vs. medicalised) remains debated.○Objective decision criteria are lacking in triage practice.
What this paper adds
○FiO2 > 40% (HFNC), or FiO2 > 35% (CPAP), or pCO2 > 65 mmHg predict need for medical team.○Most transfers can be safely managed by nurse‐led teams when below these thresholds.○Provides evidence‐based criteria to guide nursing triage and support advanced practice roles.

What is known about the topic
○Bronchiolitis is a major cause of PICU transfer in infants.○Team composition during transport (nurse‐led vs. medicalised) remains debated.○Objective decision criteria are lacking in triage practice.

Bronchiolitis is a major cause of PICU transfer in infants.

Team composition during transport (nurse‐led vs. medicalised) remains debated.

Objective decision criteria are lacking in triage practice.

What this paper adds
○FiO2 > 40% (HFNC), or FiO2 > 35% (CPAP), or pCO2 > 65 mmHg predict need for medical team.○Most transfers can be safely managed by nurse‐led teams when below these thresholds.○Provides evidence‐based criteria to guide nursing triage and support advanced practice roles.

FiO2 > 40% (HFNC), or FiO2 > 35% (CPAP), or pCO2 > 65 mmHg predict need for medical team.

Most transfers can be safely managed by nurse‐led teams when below these thresholds.

Provides evidence‐based criteria to guide nursing triage and support advanced practice roles.