Implementation of High-Flow Nasal Cannula on Bronchiolitis Patients ≤ 24 Months Within the General Pediatric In-Patient Ward

Background:

Heated high-flow nasal cannula (HFNC) has been used for treatment of bronchiolitis. Traditionally, HFNC was restricted to the ICU setting. The objective of this study was to assess implementation of HFNC at a small academic institution within a large adult hospital without dedicated respiratory therapists.

Methods:

In 2017, guidelines were developed to initiate HFNC for bronchiolitis treatment on the general pediatrics floor. Initiation of flow using Fisher & Paykel Opti-flow Jr nasal cannula was based on age (10 L/min for >90 days, 8L/min for <90 days). A retrospective chart review was conducted on patients ≤24 months old who were hospitalized from 2015-2019 with bronchiolitis and received HFNC.

Results:

Retrospective chart review was conducted on 244 patients and final analyses were conducted on 145 patient charts that met criteria; 71 patients pre HFNC implementation and 74 patients post. After implementation of HFNC on the floor, fewer patients were directly admitted to the PICU (38% post vs. 59% pre; P = .02) and fewer patients were intubated with more using CPAP (13% intubated pre vs.3% post; 20% CPAP pre vs. 39% post; P = .02). Patients were on HFNC for similar amount of time (46 hours pre vs. 43 hours post; P = .33) however, HFNC was started earlier in the hospitalization (post 5 hours vs 10 hours pre; P = .01) and at higher flows (1.3 L/kg post vs. 1.0 L/kg pre, P = .01). There was a decrease in LOS, although not statistically significant (5.7 days pre vs. 4.7 days post, P = .17). Hospital charges decreased following implementation ($22,662 post vs. $32,853 pre, P = .002). There were no severe adverse outcomes including pediatric codes, or intubations. Three patients had aspiration events, one requiring PICU transfer and eventually CPAP initiation.

Conclusions:

Our institution is a smaller academic center without a dedicated respiratory therapist to our unit or pediatric specialized RTs. HFNC was able to be implemented on our general pediatrics floor safely with some benefits including decrease intubations, trend towards shorter LOS, and decrease hospital charges for children hospitalized with bronchiolitis on HFNC. More research is needed to determine the impact of early initiation of HFNC on intubation rates and cost/benefit analysis of the increased use of HFNC nationwide over the past few years.

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