Transition to Weight-Based High-Flow Nasal Cannula Use Outside of the ICU for Bronchiolitis

Robert J Willer1, Patrick W Brady2, Amy N Tyler3

  • 1Department of Pediatrics, Division of Pediatric Hospital Medicine, University of Utah School of Medicine, Primary Children's Hospital, Salt Lake City.

JAMA Network Open
|March 18, 2024
PubMed

Insights

Implementing weight-based high-flow nasal cannula (HFNC) protocols outside the intensive care unit (ICU) for bronchiolitis is associated with fewer ICU admissions. This study shows a significant decrease in ICU admissions after hospitals adopted these non-ICU HFNC protocols.

Area of Science:

  • Pediatric Respiratory Medicine
  • Healthcare Quality Improvement
  • Clinical Protocol Implementation

Background:

  • Many children's hospitals use weight-based high-flow nasal cannula (HFNC) protocols for bronchiolitis outside the intensive care unit (ICU).
  • The effectiveness of these protocols in reducing ICU admissions for bronchiolitis is not well-established.

Purpose of the Study:

  • To evaluate the association between hospitals transitioning to weight-based non-ICU HFNC protocols and subsequent ICU admission rates for bronchiolitis.
  • To determine if updated protocols reduce the need for intensive care interventions.

Main Methods:

  • A multicenter retrospective cohort study utilizing a controlled interrupted time series approach.
  • Included 18 children's hospitals and analyzed data from 86,046 patients aged 0-24 months hospitalized with bronchiolitis (2010-2021).
  • Compared outcomes between hospitals using ICU-only protocols versus those adopting weight-based non-ICU HFNC protocols.

Main Results:

  • Hospital transition to weight-based non-ICU HFNC protocols was associated with a 6.1% annual decrease in ICU admissions.
  • A 1.5% annual reduction in noninvasive positive pressure ventilation use was observed with the new protocols.
  • No significant differences were found in mean length of stay or invasive mechanical ventilation rates.

Conclusions:

  • Transitioning to weight-based non-ICU HFNC protocols for bronchiolitis is linked to decreased ICU admission rates.
  • These findings suggest that wider adoption of these protocols could improve resource utilization and patient outcomes.
  • Further research should explore long-term impacts and optimal implementation strategies.
Abstract

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