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Implementation of a Feeding Protocol in Patients With Humidified HIGH Flow Nasal Cannula in a Pediatric Intensive
Javier Rodriguez-Fanjul1,2, Felipe Stacey3, Unai Urrutia3
1Pediatric Intensive Care Unit, Pediatric Service. Hospital Germans Trias i Pujol, Universitat Autonoma de Barcelona, Badalona, Spain.
Insights
Implementing a nutrition protocol for children with bronchiolitis on Humidified high flow nasal cannula (HHFNC) significantly speeds up enteral nutrition (EN) initiation and caloric goals without adverse events, reducing hospital stays.
Area of Science:
- Pediatric Intensive Care
- Critical Care Nutrition
- Respiratory Illness Management
Background:
- Limited evidence exists for enteral nutrition (EN) in pediatric patients with bronchiolitis on Humidified high flow nasal cannula (HHFNC).
- Concerns regarding aspiration and mechanical ventilation risk often lead to withholding EN.
- Optimizing nutrition is crucial for recovery in critically ill children.
Purpose of the Study:
- To evaluate the impact of a standardized enteral nutrition protocol on children with bronchiolitis receiving HHFNC.
- To decrease the time to initiation of EN in this patient population.
- To assess the safety and efficacy of early EN initiation.
Main Methods:
- A quality improvement project comparing pre- and post-intervention periods in a pediatric intensive care unit (PICU).
- Development of a stakeholder-driven algorithm to increase EN use.
- Data collection on time to EN initiation, caloric goals, HHFNC duration, and adverse events.
Main Results:
- Median time to EN initiation decreased from 24 to 4 hours post-protocol implementation (p < 0.05).
- No aspiration events or other adverse effects were documented.
- Faster achievement of target caloric intake was observed.
Conclusions:
- A standardized EN pathway for children on HHFNC accelerates nutrition delivery and goal achievement.
- Early EN initiation is safe and associated with reduced HHFNC duration, PICU length of stay, and hospital length of stay.
- This protocol can optimize care for pediatric bronchiolitis patients requiring respiratory support.
Purpose:
There is limited evidence to guide the use of enteral nutrition (EN) for children with bronchiolitis who received Humidified high flow nasal cannula (HHFNC) and often kept nil per mouth for aspiration and progression to mechanical ventilation risk.
Methods:
This quality improvement project included children with bronchiolitis who were supported by HHFNC in the paediatric intensive care unit (PICU). An algorithm to increase EN use in those participants was created by stakeholders. Two periods of time were compared: Group 1 pre-intervention (October 1, 2022-May 1, 2023): without nutrition implementation protocol vs Group 2 (October 1, 2023-May 1 2024), once the protocol was implemented. EN was provided via naso-gastric tubes. The project aim was to decrease the mean time to initiation of EN by more than 50% after the start of HHFNC. Secondary endpoints were time to reach target calories (100 kcal/kg/day), HHFNC total duration, and the proportion of subjects with adverse effects.
Results:
A total of 98 patients were included in the study. Forty five children in group 1, 53 children in group 2. Median time to the start of EN decreased from 24 (16-24) to 4 (2-6) hours (p < 0.05). No episodes of aspiration or other adverse effect were documented.
Conclusions:
The implementation of a standardized pathway for EN in children with HHFNC was associated with faster initiation of EN and a shorter time to reaching caloric goals without adverse events. Moreover, there was a reduction in the group 2 in the days of HHFNC, PICU length of stay (LOS) and Hospital LOS.
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