The Current State of High-Flow Nasal Cannula Protocols at Children's Hospitals

To describe the current state of non-ICU high flow nasal cannula (HFNC) protocols at children's hospitals and explore associations between HFNC protocol type and utilization outcomes.

We performed a cross-sectional study of the Pediatric Health Information Systems (PHIS) database. First, we designed a survey with the purpose of classifying HFNC protocols used at hospitals currently contributing data to PHIS. Next, we categorized hospitals based on their current HFNC protocol (ICU only, age-based non-ICU, or weight-based non-ICU). Finally, using the PHIS database, we compared hospital characteristics and patient-level bronchiolitis outcomes by HFNC protocol group.

We received survey responses from 36 of 44 (82%) hospitals contributing data to PHIS in 2021. During the time period studied, there was a steady increase in adoption of non-ICU HFNC protocols, with 71% of responding children's hospitals reporting non-ICU HFNC protocols in 2021 compared with 11% before 2010. No differences in hospital characteristics were observed between ICU-only hospitals, age-based hospitals, or weight-based hospitals. Age-based hospitals had the highest proportion of bronchiolitis patients treated in the ICU (36.1%), whereas weight-based hospitals had the lowest proportion of patients treated in the ICU (21.0%, P < .001). Length of stay was longer at age-based hospitals (2.9 days) as compared with weight-based and ICU-only hospitals (1.9 days, P < .001).

Most children's hospitals have adopted non-ICU HFNC protocols for patients with bronchiolitis, the majority of which are now utilizing weight-based maximum flow rates. Weight-based HFNC protocols were associated with decreased ICU utilization compared with age-based HFNC protocols.