Liberalizing Maximum High-Flow Nasal Cannula Flow Rates in the General Inpatient Ward Is Associated With Decreased...

Area of Science:

• Pediatrics
• Respiratory Medicine
• Critical Care Medicine

Background:

• Bronchiolitis is a common pediatric respiratory infection.
• High-flow nasal cannula (HFNC) oxygen therapy is increasingly used for infants with bronchiolitis.
• Previous guidelines limited HFNC flow rates in inpatient (IP) wards.

Purpose of the Study:

• To evaluate the impact of increased HFNC flow rate maximums on intensive care utilization in infants with bronchiolitis.
• To assess the safety of higher HFNC flow rates in the IP setting.

Main Methods:

• Retrospective pre-post cohort study at a tertiary care children's hospital.
• Included infants without complex chronic conditions presenting with bronchiolitis (2018-2020).
• Analyzed patient disposition, IP to pediatric intensive care unit (PICU) transfer, care escalation, and hospital length of stay before and after a policy change increasing allowable HFNC flow rates to 2 L/min/kg on IP wards.

Main Results:

• No significant increase in overall hospital admission rates after adjusting for confounders.
• A significant reduction in PICU admissions was observed.
• No increase in the risk of IP-to-PICU transfer, care escalation, or hospital length of stay.

Conclusions:

• Increasing HFNC flow rates to 2 L/min/kg on IP wards is associated with decreased intensive care admissions for infants with bronchiolitis.
• The policy change appears safe, as evidenced by stable rates of care escalation and length of stay.