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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.
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.
Importance:
Most children's hospitals have adopted weight-based high-flow nasal cannula (HFNC) bronchiolitis protocols for use outside of the intensive care unit (ICU) setting. Whether these protocols are achieving their goal of reducing bronchiolitis-related ICU admissions remains unknown.
Objective:
To measure the association between hospital transition to weight-based non-ICU HFNC use and subsequent ICU admission.
Design, Setting, And Participants:
This multicenter retrospective cohort study was conducted with a controlled interrupted time series approach and involved 18 children's hospitals that contribute data to the Pediatric Health Information Systems database. The cohort included patients aged 0 to 24 months who were hospitalized with a diagnosis of bronchiolitis between January 1, 2010, and December 31, 2021. Data were analyzed from July 2023 to January 2024.
Exposure:
Hospital-level transition from ICU-only to weight-based non-ICU protocol for HFNC use. Data for the ICU-only group were obtained from a previously published survey.
Main Outcomes And Measures:
Proportion of patients with bronchiolitis admitted to the ICU.
Results:
A total of 86 046 patients with bronchiolitis received care from 10 hospitals in the ICU-only group (n = 47 336; 27 850 males [58.8%]; mean [SD] age, 7.6 [6.2] years) and 8 hospitals in the weight-based protocol group (n = 38 710; 22 845 males [59.0%]; mean [SD] age, 7.7 [6.3] years). Mean age and sex were similar for patients between the 2 groups. Hospitals in the ICU-only group vs the weight-based protocol group had higher proportions of Black (26.2% vs 19.8%) and non-Hispanic (81.6% vs 63.8%) patients and patients with governmental insurance (68.1% vs 65.9%). Hospital transition to a weight-based HFNC protocol was associated with a 6.1% (95% CI, 8.7%-3.4%) decrease per year in ICU admission and a 1.5% (95% CI, 2.8%-0.1%) reduction per year in noninvasive positive pressure ventilation use compared with the ICU-only group. No differences in mean length of stay or the proportion of patients who received invasive mechanical ventilation were found between groups.
Conclusions And Relevance:
Results of this cohort study of hospitalized patients with bronchiolitis suggest that transition from ICU-only to weight-based non-ICU HFNC protocols is associated with reduced ICU admission rates.
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