Implementation of a Weight-Based High-Flow Nasal Cannula Protocol for Children With Bronchiolitis

To determine if the implementation of a weight-based high-flow nasal cannula (HFNC) protocol for infants with bronchiolitis was associated with improved outcomes, including decreased ICU use. We implemented a weight-based HFNC protocol across a tertiary care children's hospital and 2 community...

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Bibliographic Details
Published in:	Hospital pediatrics Vol. 11; no. 8; p. 891
Main Authors:	Willer, Robert J, Johnson, Michael D, Cipriano, Frank A, Stone, Bryan L, Nkoy, Flory L, Chaulk, David C, Knochel, Miguel L, Kawai, Cynthia K, Neiswender, Kristi L, Coon, Eric R
Format:	Journal Article
Language:	English
Published:	United States 01-08-2021
Subjects:	Bronchiolitis - therapy Cannula Child Child, Preschool Chronic Disease Hospitalization Humans Infant Multicenter Studies as Topic Noninvasive Ventilation Oxygen Inhalation Therapy
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Summary:	To determine if the implementation of a weight-based high-flow nasal cannula (HFNC) protocol for infants with bronchiolitis was associated with improved outcomes, including decreased ICU use. We implemented a weight-based HFNC protocol across a tertiary care children's hospital and 2 community hospitals that admit pediatric patients on HFNC. We included all patients who were <2 years old and had a discharge diagnosis of bronchiolitis or viral pneumonia during the preimplementation (November 2013 to April 2018) and postimplementation (November 2018 to April 2020) respiratory seasons. Data were analyzed by using an interrupted time series approach. The primary outcome measure was the proportion of patients treated in the ICU. Patients with a complex chronic condition were excluded. Implementation of the weight-based HFNC protocol was associated with an immediate absolute decrease in ICU use of 4.0%. We also observed a 6.2% per year decrease in the slope of ICU admissions pre- versus postintervention. This was associated with an immediate reduction in median cost per bronchiolitis encounter of $661, a 2.3% immediate absolute reduction in the proportion of patients who received noninvasive ventilation, and a 3.4% immediate absolute reduction in the proportion of patients who received HFNC. A multicenter, weight-based HFNC protocol was associated with decreased ICU use and noninvasive ventilation use. In hospitals where HFNC is used in non-ICU units, weight-based approaches may lead to improved resource use.
ISSN:	2154-1671
DOI:	10.1542/hpeds.2021-005814