Non-invasive Ventilation in Pediatric Bronchiolitis: Variables Related to Weaning Readiness and Efficacy

Non-invasive Ventilation in Pediatric Bronchiolitis: Variables Related to Weaning Readiness and Efficacy | Authorea try { document.documentElement.classList.add('js'); } catch (e) { } var _gaq = _gaq || []; _gaq.push(['_setAccount', 'G-8VDV14Y67G']); _gaq.push(['_trackPageview']); (function() { var ga = document.createElement('script'); ga.type = 'text/javascript'; ga.async = true; ga.src = ('https:' == document.location.protocol ? 'https://ssl' : 'http://www') + '.google-analytics.com/ga.js'; var s = document.getElementsByTagName('script')[0]; s.parentNode.insertBefore(ga, s); })(); Skip to main content Preprints Collections Wiley Open Research IET Open Research Ecological Society of Japan All Collections About About Authorea FAQs Contact Us Quick Search anywhere Search for preprint articles, keywords, etc. Search Search ADVANCED SEARCH SCROLL This is a preprint and has not been peer reviewed. Data may be preliminary. 5 November 2025 V1 Latest version Share on Non-invasive Ventilation in Pediatric Bronchiolitis: Variables Related to Weaning Readiness and Efficacy Authors : Rheanna Bulten , Gregory Hansen , and Tanya Holt 0000-0002-3895-0680 [email protected] Authors Info & Affiliations https://doi.org/10.22541/au.176232805.55892865/v1 249 views 98 downloads Contents Abstract Information & Authors Metrics & Citations View Options References Figures Tables Media Share Abstract Background: There is a lack of evidence related to weaning non-invasive ventilation in bronchiolitis. The purpose of this study was to identify variables related to NIV weaning readiness, efficacy, and approach in bronchiolitis. Methods: Retrospective cohort study of 74 children, less than two years of age with bronchiolitis, requiring NIV and admitted to a pediatric intensive care unit (PICU) from 2022 to 2023. Demographic variables, clinical metrics, NIV mode, and weaning metrics were collected. Results: Mean total duration of NIV therapy was 40 hours with weans lasting 13 hours. Duration for children on CPAP alone was shorter (26 hours) than for children on combination of BiPAP and CPAP (45 hours, 95% CI 4.258 to 33.742, P = 0.0123). Wean times were also shorter for children on CPAP alone (mean 5 hours) than children on BiPAP and CPAP (mean 16 hours) (95% CI 1.899 to 20.101, P = 0.0185). Patients were more likely to have a ‘complex wean,’ defined as escalation and de-escalation between multiple settings, with BiPAP (44.6%) than with CPAP (18.8 %). RR at first wean was a significant predictor of NIV weaning duration (p=0.007). Conclusion: There is a need for NIV weaning guidelines. RR may be an important predictor of NIV weaning readiness and efficacy. A ‘complex wean’ may be a potential outcome variable for weaning NIV in children with bronchiolitis. This study may be used to inform future research and guidelines for weaning NIV in children with bronchiolitis. Original Research Non-invasive Ventilation in Pediatric Bronchiolitis: Variables Related to Weaning Readiness and Efficacy Rheanna Bulten 1 MD MSc Gregory Hansen 2 MD MPH MSc FRCPC Tanya Holt 2 MD MSc FRCPC Departments and Institutions 1 Univeristy of Saskatchewan, Department of Pediatrics, Saskatchewan, Canada. 2 Jim Pattison Children’s Hospital. Pediatric Intensive Care. Saskatchewan, Canada. Corresponding Author: Tanya Holt, Pediatric Intensive Care Unit. Jim Pattison Children’s Hospital. 103 Hospital Drive, Saskatoon, Saskatchewan, S7N 0W8, Canada. Email: [email protected] Data Presentation: Child Health Research Day April 2025, Saskatoon SK, Canada. Presented by Rheanna Bulten. Conflicts of Interest: All authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. Financial Support : None of the authors have sources of financial support to declare. Author Contribution: RB completed a literature review, data collection, and contributed to the writing and editing of the final manuscript. GH co-conceptualized the study, completed statistical analyses, and contributed to the writing and editing of the final manuscript. TH co-conceptualized the study, completed statistical analyses, and contributed to the writing and editing of the final manuscript. Abstract Background: There is a lack of evidence related to weaning non-invasive ventilation in bronchiolitis. The purpose of this study was to identify variables related to NIV weaning readiness, efficacy, and approach in bronchiolitis. Methods: Retrospective cohort study of 74 children, less than two years of age with bronchiolitis, requiring NIV and admitted to a pediatric intensive care unit (PICU) from 2022 to 2023. Demographic variables, clinical metrics, NIV mode, and weaning metrics were collected. Results: Mean total duration of NIV therapy was 40 hours with weans lasting 13 hours. Duration for children on CPAP alone was shorter (26 hours) than for children on combination of BiPAP and CPAP (45 hours, 95% CI 4.258 to 33.742, P = 0.0123). Wean times were also shorter for children on CPAP alone (mean 5 hours) than children on BiPAP and CPAP (mean 16 hours) (95% CI 1.899 to 20.101, P = 0.0185). Patients were more likely to have a ‘complex wean,’ defined as escalation and de-escalation between multiple settings, with BiPAP (44.6%) than with CPAP (18.8 %). RR at first wean was a significant predictor of NIV weaning duration (p=0.007). Conclusion: There is a need for NIV weaning guidelines. RR may be an important predictor of NIV weaning readiness and efficacy. A ‘complex wean’ may be a potential outcome variable for weaning NIV in children with bronchiolitis. This study may be used to inform future research and guidelines for weaning NIV in children with bronchiolitis. Key Words: Bronchiolitis, critical care, infant, non-invasive ventilation, ventilator weaning Introduction Bronchiolitis is the most common cause of hospitalization for children less than 2 years 1,2 . In severe cases, non-invasive ventilation (NIV) has gained significant footing in pediatric intensive care settings to provide respiratory support without the need for intubation 3-6 . Despite its increased use, there are no evidence-based pediatric protocols for weaning. Weaning efficacy is important because NIV has been associated with numerous risks including aspiration, barotrauma, reduced preload, and skin and mucosal breakdown 7 . In children with bronchiolitis, a step-down approach to weaning may lead to an increased duration of NIV 8 while weaning strategies using high flow nasal cannula for de-escalation of NIV may lead to shorter PICU stays 9 . Surveys of weaning practices have shown non-uniformity 10 . Notably, there are very limited studies identifying weaning protocols for NIV. There is also large variability in weaning de-escalation signals. Studies have identified respiratory rate, wheeze, and retractions as markers of disease severity 11 . Other studies have suggested apneas, degree of respiratory distress, respiratory rate, hemodynamic status, and oxygen need may prompt NIV weaning initiation and identify failure 10,12 . Clinical scoring tools such as the PELOD may be indicators of disease severity 13 but have been very scarcely used in the context of weaning NIV on bronchiolitis. In 2024, a consensus panel reported high agreement for level of oxygenation, respiratory rate, and signs of respiratory distress being fundamental measures for weaning NIV. However, the panel agreed evidence-based criteria remained scarce, and future studies investigating weaning NIV in children were urgently needed 14 . In summary, there is a dearth of evidence for weaning NIV in children with bronchiolitis, and no uniform variables have been identified to initiative weaning. While expert consensus suggests the weaning process should be standardized 14 , opinions are not consolidated on how it should happen 10 . The primary purpose of this retrospective cohort study was to identify variables related to NIV weaning readiness in bronchiolitis, and to explore how weaning approach relates to weaning success. These results may help inform prospective research on developing an evidence-based weaning protocol of NIV in bronchiolitis. Variables This retrospective study was approved by the University of Saskatchewan’s research ethics board and the study received exemption from informed consent given its retrospective and anonymous data. (HREB 4103) Pediatric patients were identified through the Saskatchewan PICU’s admission registry. Inclusion criteria were i) all pediatric patients under the age of 24 months; ii) admitted to the Jim Pattison Children’s Hospital (JPCH) PICU between July 1, 2022, and July 1, 2023; iii) with a diagnosis of bronchiolitis; and iv) managed with NIV. In Saskatchewan, all children requiring NIV are managed in the PICU. The exclusion criteria were children with i) any cardiac disease, including cardiac anomalies and previous cardiac surgery; ii) chronic lung disease and/or on home oxygen; iii) anatomic airway abnormalities; iv) an immunodeficiency; v) apnea; vi) neuromuscular disease; vii) born requiring conventional mechanical ventilation. All children included in this study tested positive by nasopharyngeal polymerase chain reaction for a viral pathogen. Bronchiolitis was defined as a viral respiratory tract infection causing swelling and irritation of the bronchioles. Non-invasive ventilation included the use of continuous positive pressure ventilation (CPAP) and/or bilevel positive airway pressure (BiPAP). The term complex NIV wean emerged following data analysis and was defined as an NIV weaning course that included at least one of (1) an escalation of NIV settings [e.g., an increase in EPAP (expiratory PAP), IPAP (inspiratory PAP), Fi02], (2) an escalation of NIV modalities (e.g., CPAP to BiPAP), or both. A pediatric resident (RB) and pediatric intensivist (TH) conducted all the electronic chart reviews. Data was stored on a password protected Excel file in a secure cloud. Variables included age, prematurity, sex, weight, respiratory virus(es) isolated, comorbidities, antibiotic, secondary bacterial infection, oxygen saturation (Sp0 2 ), respiratory rate (RR), Fraction of inspired oxygen (FiO 2 ), C-reactive protein (CRP), complete blood count (CBC), pediatric logistic organ dysfunction (PELOD2) score on admission, and blood gas results (i.e., blood pH, hemoglobin, pC0 2 , HCO 3 values). NIV data included setting (mode; cm H 2 0) at admission, max, and during weaning, highest FiO 2 , total duration on NIV, highest NIV support (cm H 2 O), FiO 2 and NIV setting when wean began, duration of wean, and frequency of complex weans. Outcomes included PICU length of stay (LOS) in days, hospital LOS in days, PICU days to low flow oxygen in days, 7-day readmission rate, 7-day ED visit rate, 30-day readmission rate, 30-day ED visit rate, and failure of rescue NIV (defined as going from NIV to conventional mechanical ventilation [CMV]). Statistics All statistical analysis was completed using SPSS for Windows, version 24. All data was pooled, and unique identifiers were removed. Discrete variables were reported as percentages, and continuous data were reported means and standard deviations. Descriptive statistics were used to compare clinical features and characteristics of PICU patients. Difference of means or Fisher’s exact test were used for further data analysis. Statistical significance was considered established at an alpha of 0.05. Results Seventy-four children met inclusion criteria and are summarized in Table 1. Most children identified in our study were under the age of 12 months. All admission PELOD2 scores were between 0-1. The majority (59.5%) were infected with RSV, and nearly 15% had two or more viruses isolated. Forty three percent had a confirmed secondary bacterial infection, and sixty eight percent were treated with antibiotics. Those with confirmed bacterial infections had significantly higher CRP values (68 versus 32%; p value 0.0008). NIV data is presented in Table 2. Children receiving BiPAP required significantly longer duration of support (45.0 versus 26.0 hours; p = 0.01) and wean time (16.0 versus 5.0 hours; p = 0.02), had higher maximal fraction of inspired oxygen (38.0 versus 32.9%; p = 0.04), were more tachypneic at first wean (46.7 versus 39.3 RR; p = 0.01) and subjected to more complex weans (44.6 versus 18.8%; p < 0.05). No patient required escalation to mechanical ventilation. Specific to BiPAP weaning, the first wean occurred with IPAP, EPAP or both levels simultaneously were 46.8% (n = 26), 5.4% (n = 3) and 48.2% (n = 27), respectively. The first mean IPAP wean was 9.0 cm H 2 0 (SD 7.4) while the first mean EPAP wean was 3.1 cm H 2 0 (SD 2.3). In five instances (8.9%), BiPAP was initially weaned off NIV support. However, nearly all (n = 4; 80%) experienced complex weans. In total, 44.6% (n = 25) of children experienced complex weans. Several variables were investigated as possible predictors of NIV wean duration and are summarized in Table 3. All admission variables were not found to predict NIV weaning duration. Respiratory rate at first wean however, was a significant predictor of NIV weaning duration. (p=0.007). First wean respiratory rates equal to or greater than 40 breaths per minutes (n = 45) had significantly longer weans than patients with less than 40 breaths per minute (17.9 versus 5.0 hours; p = 0.007). Regarding outcomes, total PICU days were not significantly different between the CPAP and BiPAP groups (3.94 versus 5.11 days; p = 0.1887). Total hospital days were also not significantly different between the groups (5.77 versus 6.79 days; p = 0.1691). For all comers, our seven-day readmission rate was 1.4%, and thirty-day readmission rate was 2.7%. Discussion This retrospective cohort study evaluated variables related to NIV weaning for patients with bronchiolitis. The results highlighted the variability of weaning practices, exposed the notion of a complex wean, and introduced respiratory rate as a predictor of NIV weaning efficiency. In our PICU, weaning practices for NIV were not uniform. Different strategies of weaning were shown by initial reductions of IPAP, EPAP, or both simultaneously. Some patients were even weaned off of NIV as the initial step. Decremental weans of IPAP and EPAP were also highly variable as suggested by their large standard deviations. However, without a standardized method or protocol, and despite arguably overzealous weans at times, our patients with bronchiolitis were still weaned from NIV in less than 24 hours. Although a standardized approach may have decreased the duration of the wean, the potential clinical advantages of this reduction would likely be minimal. Rather, a focus on when to begin the wean would likely lead to appreciably shortening NIV duration. Our study found several children who were not weaned in a decremental step wise fashion. Rather, some were escalated and de-escalated multiple times between settings and/or modalities. We labelled this observation as “complex weans” and to our knowledge it has not been described with bronchiolitis. In a study by Mortamet and colleagues 14 , expert consensus labelled a successful wean off of NIV after 24-48h with no respiratory support, and a weaning failure as a need to reinstall any type of respiratory support (invasive or noninvasive). No consensus was reached regarding weaning procedure. The panel did not address various escalation between settings and modalities during NIV weaning. In 2023, Cassiba and colleagues 8 employed a step wise wean from NIV to CPAP to high flow nasal cannula and defined weaning failure as a switch back to previous modes of support. Similarly, a nurse-driven protocol in 2025 used a step wise approach to wean infants off CPAP, with infants who failed being escalated back to previous mode of support 12 . Escalation of settings and numerous switches between support modalities were not reported. The concept of a complex wean was important in the current study as children on BiPAP were more likely to experience a complex wean, and children on BiPAP who were put on RA almost unanimously had a complex wean. The idea of a complex wean suggests children may not have had an optimal wean, and this may be due to difficulty identifying patients who were ready to wean, difficulty identifying triggers to wean, or a combination. Work of breathing may also play a role, as many children were sometimes escalated on their support due to clinical work of breathing without changes in other clinical measures or vital signs. Identifying clear variables to initiate weaning of NIV, particularly for children on BiPAP, may help limit complex weans and appreciably shorten NIV wean times. Finally, admission variables of comorbidities, sex, RSV status, and admission vital signs were not found to predict NIV weaning duration. This was not surprising as it suggests weaning time was less related to admission variables and more related to identification of a physiological window in which patients could be weaned regardless of how unwell they were on admission. Notably, respiratory rate was identified as a significant variable predicting duration of NIV wean. Specifically, a RR of 40 was shown to be a critical point after which weaning durations became longer. As minute ventilation is a product of respiratory rate and tidal volume, higher respiratory rates are necessary to compensate for decreased tidal volumes as seen with bronchiolitis. Consistent with this, respiratory rate has been shown as an important parameter for assessing NIV weaning readiness. Expert consensus has identified respiratory rate as an important clinical criterion for weaning NIV 14 , with a RR of 60 being common for initiating weaning and identifying wean failure 10,12 . In the current study, children on BiPAP were weaned at a higher RR and had more complex weans on average, which supports RR as an indicator of weaning readiness. Limitations This study had several limitations. First, tidal volume similarly was not captured as a variable, highlighting the limitations of a retrospective study design. Secondly, bacterial infections have been shown in the literature to be possible predictors of NIV weaning failure 15 . Bacterial infections were recorded in the current study by means of urine and blood cultures, but bacterial pneumonia was diagnosed by chest x-ray, making it difficult to draw conclusions about whether secondary bacterial infections influenced weaning duration or outcomes. Finally, admission data and NIV settings were collected from JPCH data when children were first admitted to our PICU to ensure consistency in data collection. However, vital signs or blood gas values prior to starting any form of NIV in referring centers could not be captured. Conclusion NIV has emerged as a therapeutic option for children with bronchiolitis admitted to the PICU. It follows that initiation must be matched with valid indicators for weaning and discontinuation. There is a paucity of guidelines that relate to pediatric NIV weaning protocols in bronchiolitis patients. The non-uniformity of current weaning practices was highlighted in our data and is consistent with previous literature identifying significant variability in current NIV weaning practices. Respiratory rate was identified in our data as an important predictor of NIV weaning readiness and efficiency and may be an important variable to consider in future weaning protocols. Finally, to the best of our knowledge, this is the first study to elucidate the notion of a complex wean as an outcome measure in children with bronchiolitis on NIV support. Our results may be used to inform future guidelines for weaning NIV in children with bronchiolitis admitted to PICU. References 1. Zorc JJ, Hall CB. Bronchiolitis: Recent evidence on diagnosis and management. Pediatrics 2010;125(2):342-9. 2. Worrall G. Bronchiolitis. Can Fam Physician. 2008 May;54(5):742-3. PMID: 18474710; PMCID: PMC2377231. 3. Pelletier JH, Maholtz DE, Hanson CM, et al. Respiratory Support Practices for Bronchiolitis in the Pediatric Intensive Care Unit. JAMA Netw Open. 2024 May 1;7(5):e2410746. doi: 10.1001/jamanetworkopen.2024.10746. PMID: 38728028; PMCID: PMC11087830. 4. Gutierrez Moreno M, Del Villar Guerra P, Medina, A, et al. High-flow oxygen and other noninvasive respiratory support therapies in bronchiolitis: systematic review and network meta-analyses. Pediatric Critical Care Medicine 2023,24(2):133-142; doi: https://dx.doi.org/10.1097/PCC.0000000000003139. 5. Cataño-Jaramillo ML, Jaramillo-Bustamante JC, Florez ID. Continuous positive airway pressure vs. high flow nasal cannula in children with acute severe or moderate bronchiolitis: A systematic review and meta-analysis. Med Intensiva (Engl Ed) 2020;S0210-5691(20)30324-7. 6. Tang G, Lin J, Zhang Y, et al. The effects and safety of continuous positive airway pressure in children with bronchiolitis: A systematic review and meta-analysis. J Trop Pediatr 2021; 67:fmaa128. 7. Carron M, Freo U, BaHammam AS, et al. Complications of non-invasive ventilation techniques: a comprehensive qualitative review of randomized trials. Br J Anaesth 2013;110(6):896-914. 8. Cassibba J, Freycon C, Doutau J, et al. Weaning from noninvasive ventilatory support in infants with severe bronchiolitis: An observational study. Arch Pediatr. 2023 May;30(4):201-205. doi: 10.1016/j.arcped.2023.03.003. Epub 2023 Mar 27. PMID: 36990935. 9. Mortamet, Milesi, Cassiba et al. Noninvasive respiratory support weaning in infant s with severe bronchiolitis: High flow nasal cannula may reduce the length of stay. Ped Pulm. 2025 Apr;60(4): e71108. https://doi.org/10.1002/ppul.71108. 10. Suzanne M, Amaddeo A, Pin I, et al. Weaning from non-invasive ventilation and high flow nasal cannula in bronchiolitis: a survey of practice. Pediatr Pulmonol. 2020; 55(11): 3104-3109. 11. Bedson W, Wilkinson E, Hawcutt D, et al. Severity scoring used in assessment of bronchiolitis: a systematic review. Eur Resp J 2021;58. 12. Cassibba J, Chevallier M, Alexandre A, et al. Impact of a nurse-driven noninvasive respiratory support discontinuation protocol in infants with severe bronchiolitis. Arch Pediatr. 2025 Jan;32(1):18-23. doi: 10.1016/j.arcped.2024.08.006. Epub 2024 Nov 20. PMID: 39572286. 13. Leteurtre S, Martinot A, Duhamel A, et al. Validation of the paediatric logistic organ dysfunction (PELOD) score: prospective, observational, multicentre study. Lancet 2003;362(9379):192-7. doi: 10.1016/S0140-6736(03)13908-6. 14. Mortamet G, Milési C, Baudin F, et al. Weaning from noninvasive respiratory support in children in acute settings: expert consensus statement using modified Delphi methodology. Pediatr Pulmonol 2024;59:348‐354. doi:10.1002/ppul.26753. 15. Maamari M, Nino G, Bost J, et al. Predicting failure of non-invasive ventilation with ram cannula in bronchiolitis. Journal of Intensive Care Medicine 2022;37(1), 120-127. https://dx.doi.org/10.1177/0885066620979642. Tables Table 1. Demographics and Admission Data (n = 74) Age (days), mean (SD) 189.2 (202.5) Sex (male), n (%) 45 (60.8) Weight (kg), mean (SD) 7.27 (3.22) Comorbidities n (%) 10 (13.5) RSV status, 1 n (%) 44 (59.5) Two or more viruses, 1 n (%) 11 (14.9) Other viruses 1 n (%) Rhinovirus Influenza A COVID-19 Human metapneumovirus Adenovirus Seasonal coronavirus Parainfluenza 12 (17.6) 1 (1.4) 1 (1.4) 12 (16.2) 4 (5.4) 1 (1.4) 1 (1.4) Secondary bacterial infection, 2 n (%) 32 (43.2) Sp0 2 (%), (SD) 95.7 (2.5) Respiratory rate, (SD) 43.5 (13.1) Heart rate, (SD) 160.6 (25.4) pH, (SD) 7.33(0.1) HC0 3 - (mmol/L), (SD) 24.89 (4.34) PCO 2 (mmHg), (SD) 48.01 (11.6) Lactate (mmol/L), (SD) 2.14(1.2) Hemoglobin (g/L), (SD) 116.96(17.1) Day of Illness, (SD) 3.95(1.7) C-reactive protein (mg/L), SD With bacterial infection Without bacterial infection Difference of square 52.3(56.6) 74 (67.8) 32.6 (31.9) P = 0.0008 White blood cell count (x 10 9 cells/L) 11.1 (4.4) Antibiotics, n (%) 50 (67.6) 1 Confirmed-on laboratory testing; 2 Urinary tract infections or bacteremia confirmed on laboratory testing. HCO 3 - venous bicarbonate; PCO 2 venous partial pressure carbon dioxide; RSV respiratory syncytial virus; SpO 2 peripheral oxygen saturation; SD standard deviation. Table 2: Noninvasive Ventilation data Duration (hours), SD 40.0 (28.4) 26.0 (20.6) 45.0 (29.0) 0.01 Max setting (hours), SD 27.3 (20.5) 20.6 (17.4) 29.4 (21.0) 0.07 Wean (hours), SD 13.0 (20.0) 5.0 (12.9) 16.0 (21.5) 0.02 Max FiO 2 %, SD 36.4 (10.9) 32.9 (8.3) 38.0 (11.4) 0.04 First wean FiO 2 %, SD 28.3 (7.5) 28.6 (6.5) 28.3 (7.9) 0.87 First wean SpO 2 %, SD 94.7 (2.4) 94.6 (2.5) 95.1 (2.4) 0.49 First wean RR, SD 43.5 (12.3) 39.3 (11.3) 46.7 (12.4) 0.01 Complex wean total, n (%) 28 (38.0) 3 (18.8) 25 (44.6) <0.05 BiPAP bilevel positive airway pressure; CPAP continuous positive airway pressure; FiO 2 fraction of inspired oxygen; NIV noninvasive ventilation; RR respiratory rate; SpO 2 peripheral oxygen saturation; SD standard deviation. Table 3. Difference of Means for NIV Wean Duration (hours) Comorbidities Yes No 10 64 8.5 (13.9) 13.3 (21.1) -8.35 to 19.15 0.44 RSV status Yes No 44 30 14.1 (11.9) 20.5 (20.1) -11.80 to 7.40 0.65 Sex Male Female 45 29 13.8 (12.2) 22.7 (16.2) -111.29 to 8.09 0.74 Admission Sp0 2 90-94 95-100 24 50 13.8 (12.9) 20.1 (20.5) -10.98 to 9.19 0.86 Admission RR 40 39 35 10 (16.7) 18.6 (21.7) -2.64 to 16.04 0.16 First Wean RR 40 28 45 5 (17.9) 11.2 (23) 3.60 to 22.20 0.007 BiPAP bilevel positive airway pressure; CPAP continuous positive airway pressure; FiO 2 fraction of inspired oxygen; NIV noninvasive ventilation; RR respiratory rate; SpO 2 peripheral oxygen saturation; SD standard deviation. Information & Authors Information Version history V1 Version 1 05 November 2025 Copyright This work is licensed under a Non Exclusive No Reuse License. Keywords bronchiolitis critical care infant non-invasive ventilation ventilator weaning Authors Affiliations Rheanna Bulten University of Saskatchewan Department of Pediatrics View all articles by this author Gregory Hansen Royal University Hospital Children's Services View all articles by this author Tanya Holt 0000-0002-3895-0680 [email protected] Royal University Hospital Children's Services View all articles by this author Metrics & Citations Metrics Article Usage 249 views 98 downloads .FvxKWukQNSOunydq8rnd { width: 100px; } Citations Download citation Rheanna Bulten, Gregory Hansen, Tanya Holt. Non-invasive Ventilation in Pediatric Bronchiolitis: Variables Related to Weaning Readiness and Efficacy. Authorea . 05 November 2025. DOI: https://doi.org/10.22541/au.176232805.55892865/v1 If you have the appropriate software installed, you can download article citation data to the citation manager of your choice. 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