2026/03/23 by Arthur Gaudaire, C. Milesi, Alexia Morel +7 · 1 voice
Medicine · #Respiratory viral infections research #Trauma and Emergency Care Studies #Travel-related health issues
paper · doi:10.1111/nicc.70460
openalex publication_date 2026/03/23 · openalex created_date 2026/03/24 · openalex updated_date 2026/07/22
ABSTRACT Background 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. Aim 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. Study Design 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, FiO 2 and blood gas values—were analysed for their ability to predict the occurrence of such interventions using receiver operating characteristic (ROC) analysis. Results Among 167 included infants (mean age 157 ± 169 days; weight 5.9 ± 2.7 kg), 20 (12%) required a clinical intervention. Higher FiO 2 (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 pCO 2 (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 FiO 2 > 40%, or continuous positive airway pressure (CPAP) with FiO 2 > 35% or pCO 2 > 65 mmHg predicted the need for a medicalised team (AUC = 0.83; sensitivity 90%, specificity 78%, negative predictive value 98%). Conclusions 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. Relevance to Clinical Practice 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. FiO 2 and pCO 2 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.