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Feeding Pathway for Children on High Flow Nasal Cannula Decreases Time to Enteral Nutrition

Sara H Soshnick1, Gabriella S Mark2, Jacqueline Weingarten-Arams1

  • 1Department of Pediatrics, Division of Critical Care, The Children's Hospital at Montefiore, Bronx, N.Y.

Pediatric Quality & Safety
|December 15, 2022
PubMed

Insights

Implementing a standardized enteral nutrition (EN) pathway for children on High Flow Nasal Cannula (HFNC) significantly reduced time to EN initiation and goal caloric delivery. This quality improvement initiative improved nutritional support for critically ill pediatric patients without increasing adverse events.

Area of Science:

  • Pediatric Critical Care Medicine
  • Nutritional Support
  • Quality Improvement

Background:

  • High Flow Nasal Cannula (HFNC) is a common respiratory support for children with respiratory failure.
  • Lack of standardized guidelines for enteral nutrition (EN) in pediatric patients on HFNC.
  • Early EN in critically ill children is linked to better outcomes, including shorter hospital stays and fewer infections.

Purpose of the Study:

  • To decrease the mean time to EN initiation by 50% in pediatric patients receiving HFNC within 6 months.
  • To implement and evaluate a standardized EN pathway for critically ill children on HFNC.

Main Methods:

  • A quality improvement project utilizing the Model for Improvement and Plan-Do-Study-Act cycles.
  • Development of a multidisciplinary EN pathway for critically ill patients on HFNC.
  • Statistical process control charts were used to analyze outcomes, including time to EN initiation, time to goal caloric EN, HFNC duration, and adverse events.

Main Results:

  • The mean time to EN initiation decreased by 47.5% (from 24.6 to 11.7 hours).
  • Mean time to goal caloric EN decreased by 58.5% (from 25.8 to 15.1 hours).
  • No significant change in HFNC duration or episodes of aspiration was observed.

Conclusions:

  • A standardized EN pathway for pediatric patients on HFNC effectively reduced the time to initiate and reach goal caloric EN.
  • The implemented pathway improved nutritional delivery efficiency without a significant increase in adverse events, such as aspiration.

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