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Bronchiolitis — RACP Paediatrics MCQ

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HardRespiratoryBronchiolitisRACP Paediatrics

A 14-month-old boy with bronchiolitis develops worsening respiratory distress despite high-flow nasal cannula (HFNC) oxygen at 2 L/kg/min. SpO2 is 88% with FiO2 0.6. He has marked subcostal and intercostal recession and a respiratory rate of 80/min. What is the most appropriate next step?

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Correct answer: D — Escalate to CPAP or intubation and mechanical ventilation

Failure to improve on maximal HFNC support with escalating FiO2 requirements (>0.4–0.5) and clinical deterioration indicates need for escalation to CPAP or intubation. The 2025 Australasian Bronchiolitis Guideline supports early ICU referral for infants failing HFNC. Pharmacological interventions (adrenaline, hypertonic saline, corticosteroids) are not supported by evidence in bronchiolitis.

Reference: PREDICT Network – 2025 – Australasian Bronchiolitis Guideline: 2025 Update