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To assess how a change in practice to more frequent use of high-flow nasal cannula for the treatment of bronchiolitis would affect the use of invasive devices in children. Design Retrospective cohort study of children under 2 years old admitted to the ICU with respiratory failure secondary to bronchiolitis. Outcomes and invasive device use were compared between two time periods, before and after the practice change. Setting Eighteen bed tertiary care PICU. Patients A total of 325 children 146 from 2010 to 2012 and 179 from 2015 to 2016