Related Experiment Video
Updated: Aug 14, 2025
Halogenated Agent Delivery in Porcine Model of Acute Respiratory Distress Syndrome via an Intensive Care Unit Type Device
Published on: September 24, 2020
Improving Outcomes for Bronchiolitis Patients After Implementing a High-Flow Nasal Cannula Holiday and Standardizing
Danielle K Maue1, Aimee Ealy2, Michael J Hobson1
1Department of Pediatrics, Division of Critical Care, Indiana University School of Medicine, Indianapolis, IN.
Insights
Implementing a respiratory therapist-driven high-flow nasal cannula (HFNC) protocol and standardized discharge criteria reduced pediatric intensive care unit (PICU) and hospital length of stay for bronchiolitis patients.
Area of Science:
- Pediatric critical care medicine
- Respiratory therapy
- Quality improvement science
Background:
- Bronchiolitis is a common cause of pediatric intensive care unit (PICU) admission.
- High-flow nasal cannula (HFNC) therapy is frequently used for respiratory support in these patients.
- Optimizing HFNC use and discharge criteria can improve patient flow and resource utilization.
Purpose of the Study:
- To decrease the duration of high-flow nasal cannula (HFNC) use.
- To reduce pediatric intensive care unit (PICU) length of stay (LOS).
- To shorten overall hospital length of stay (LOS) for pediatric patients with bronchiolitis.
Main Methods:
- A quality improvement project was conducted in a quaternary academic PICU.
- Interventions included implementing a respiratory therapist (RT)-driven HFNC protocol (PDSA 1), adjusting HFNC wean rates (PDSA 2), introducing an HFNC holiday (PDSA 3), and standardizing discharge criteria (PDSA 4).
- Data from 1,310 patients with bronchiolitis (age < 24 months) were analyzed.
Main Results:
- HFNC duration decreased from 2.5 to 1.3 days.
- PICU LOS decreased from 2.6 to 1.5 days.
- Hospital LOS decreased from 5.7 to 2.7 days.
- Use of noninvasive and invasive mechanical ventilation decreased, with no increase in readmission rates.
- PICU discharge rate increased from 6.2% to 21.5%.
Conclusions:
- Modifications to an RT-driven HFNC protocol and standardized discharge criteria significantly improved patient outcomes.
- These changes reduced HFNC duration, PICU LOS, and hospital LOS.
- The interventions were associated with improved efficiency and no increase in adverse events.
Objectives:
To decrease length of high-flow nasal cannula (HFNC), PICU, and hospital length of stay (LOS).
Design:
Quality improvement project.
Setting:
A quaternary academic PICU.
Patients:
Patients with bronchiolitis less than 24 months old.
Interventions:
After initial implementation of a respiratory therapist (RT)-driven HFNC protocol (Plan-Do-Study-Act [PDSA] 1) in October 2017, additional interventions included adjusting HFNC wean rate (PDSA 2) in July 2020, a HFNC holiday (PDSA 3), and standardized discharge criteria (PDSA 4) in October 2021.
Measurements And Main Results:
Duration of HFNC was used as the primary outcome measure. PICU LOS and hospital LOS were used as secondary outcome measures. Noninvasive ventilation use, invasive mechanical ventilation use, and 7-day PICU and hospital readmission rates were used as balancing measures. A total of 1,310 patients were included in this study. Patients in PDSA 2, PDSA 3 and 4 groups were older compared with pre-intervention and PDSA 1 (median of 9 and 10 mo compared with 8 mo; p = 0.01). HFNC duration decreased from 2.5 to 1.8 days after PDSA 1, then to 1.3 days after PDSA 2. PICU LOS decreased from 2.6 to 2.1 days after PDSA 1, 1.8 days after PDSA 2, and 1.5 days after PDSA 3 and 4. Hospital LOS decreased from 5.7 to 4.5 days after PDSA 1, 3.1 days after PDSA 2, and 2.7 days after PDSA 3 and 4. The use of noninvasive ventilation and invasive mechanical ventilation decreased throughout the study from 23.2% in the pre-intervention group, to 6.9% at the end of the project. The 7-day PICU and hospital readmission rates did not increase after implementation. The percentage of patients discharged from the PICU increased from 6.2% to 21.5%.
Conclusions:
Modifications to an existing RT-driven HFNC protocol and standardization of discharge criteria led to an improvement in outcomes for patients admitted to the PICU with bronchiolitis without an increase in adverse events.
Related Concept Videos
01:29Administering Oxygen by Nasal Cannula
Nasal Cannulas
A nasal cannula is a lightweight tube split into two prongs placed in the nostrils,...
01:23Mechanical Ventilation III: Noninvasive Ventilation
Noninvasive Positive-Pressure Ventilation...
01:30Pneumonia V: Nursing management and Prevention
The nurse must practice strict medical asepsis and adhere to infection control guidelines to minimize healthcare-associated infections.
Enhance airway patency
Position the patient correctly to facilitate drainage of the affected lung segments. Manual or mechanical percussion and vibration can also be employed....
01:29Acute Respiratory Failure-V
Ensure that patients are monitored continuously for their response to therapy, including changes in...
01:28Pneumonia IV: Management
Bacterial Pneumonia Treatment
For bacterial pneumonia, antibiotics serve as the cornerstone of therapy. Initial treatment often begins with empirical antibiotics, tailored to the anticipated causative organism and adjusted based on culture results. Key antibiotic choices include:
01:30Chronic Obstructive Pulmonary Disease-V: Nursing Management
Assessment