Related Experiment Video
Updated: Sep 28, 2025
Bronchial Thermoplasty: A Novel Therapeutic Approach to Severe Asthma
Published on: November 4, 2010
De-escalation of High-flow Respiratory Support for Children Admitted with Bronchiolitis: A Quality Improvement
Jennifer A Hoefert1,2,3, Adolfo L Molina1, Hannah M Gardner1,3
1Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Ala.
Insights
A new standardized care process for weaning infants off high-flow oxygen significantly reduced hospital stays and oxygen use in bronchiolitis patients. This quality improvement initiative improved resource utilization without compromising patient safety.
Area of Science:
- Pediatric Respiratory Medicine
- Quality Improvement Initiatives
- Hospital Resource Management
Background:
- Bronchiolitis is a leading cause of infant hospitalization, often requiring supplemental oxygen.
- Lack of standardized protocols for oxygen weaning can prolong hospital stays and increase costs.
Purpose of the Study:
- To assess the impact of a standardized care process for weaning high-flow oxygen in hospitalized bronchiolitis patients.
- To evaluate the effect on length of stay and oxygen-related resource utilization.
Main Methods:
- A single-center quality improvement project included 1-24 month olds with bronchiolitis.
- Implemented a standardized process for weaning and discontinuing high-flow oxygen.
- Monitored length of stay, time on oxygen, ICU step-down time, and safety metrics.
Main Results:
- Mean length of stay decreased from 60.7 to 46.7 hours (P < 0.01).
- Time on supplemental oxygen reduced by 47% and high-flow oxygen by 45% (P < 0.01).
- Time in ICU step-down unit decreased by 27% (P =< 0.01) with no adverse safety events.
Conclusions:
- Standardized care processes for high-flow oxygen weaning can effectively reduce length of stay.
- This approach improves resource utilization in hospitalized bronchiolitis patients.
- The implemented protocol demonstrated safety and efficiency.
Abstract:
Bronchiolitis is the most common cause for hospitalization in the first year of life, with hypoxemia and acute respiratory failure as major determinants leading to hospitalization. In addition, the lack of existing guidelines for weaning and discontinuing supplemental oxygen, including high-flow nasal cannula, may contribute to prolonged hospitalization and increased resource utilization.
Methods:
This single-center quality improvement initiative assessed the effect of implementing a standardized care process for weaning and discontinuing high-flow oxygen for patients hospitalized with bronchiolitis. Patients aged 1-24 months with bronchiolitis admitted to the general wards or ICU step-down unit from February 1, 2018, and January 31, 2020 were included in the study. Primary outcomes included length of stay and time on supplemental oxygen, with time on high-flow oxygen and length of time in ICU step-down unit as secondary outcomes. Balancing measures included transfer rate to Pediatric Intensive Care Unit, intubation rate, 7- and 30-day readmission rates, and 7- and 30-day ED visits after discharge.
Results:
Following the standardized care process implementation, the mean length of stay decreased from 60.7 hours to 46.7 hours (P < 0.01). In addition, the mean time on any supplemental oxygen decreased by 47% (P < 0.01), the mean time on high-flow oxygen decreased by 45% (P < 0.01), and the mean time in the ICU step-down unit decreased by 27% (P =< 0.01). Balancing measures remained unchanged with no statistically significant differences.
Conclusion:
Implementing a standardized care process for weaning and discontinuing high-flow oxygen may reduce the length of stay and resource utilization for patients hospitalized with bronchiolitis.
More Related Videos
06:22Surfactant Depletion Combined with Injurious Ventilation Results in a Reproducible Model of the Acute Respiratory Distress Syndrome ARDS
Published on: April 7, 2021
09:36Halogenated Agent Delivery in Porcine Model of Acute Respiratory Distress Syndrome via an Intensive Care Unit Type Device
Published on: September 24, 2020
Related Concept Videos
01:29Acute Respiratory Failure-V
Ensure that patients are monitored continuously for their response to therapy, including changes in...
01:26COPD: Management Using Bronchodilators and Corticosteroids
01:17Pulmonary Cycle: Exhalation
01:30Asthma-IV: Nursing Management
First, in...
01:17Drugs Used in Lower Respiratory Disorders: Overview
Bronchodilators, the first step of respiration enhancement, come in various forms, each with its own mechanism...
01:19Respiratory Assessment: Purpose and Indications
Objectives and Importance:
The primary goal of respiratory assessment is to evaluate patients at early risk of clinical deterioration. Since respiratory distress often precedes other signs of declining health, breathing patterns and sounds become a...