Clinical Outcomes of Bronchiolitis After Implementation of a General Ward High Flow Nasal Cannula Guideline

Abstract

Initiating a guideline for HFNC use on the general pediatric wards was associated with an increase in the use of the intervention with no significant change in total hospital length of stay, PICU length of stay and transfer rate, intubation rate, or 30-day readmission for patients with bronchiolitis.

Humidified high-flow nasal cannula oxygen for bronchiolitis: should we go with the flow?

“…The outcomes of our study support those of Kepreotes2 and Riese3 and prompt reflection: what are our actual treatment goals when using HFNC? Why has HFNC become so well established internationally without an adequate evidence base to guide appropriate use?…”

“…Current National Institute for Health and Care Excellence (NICE 2015) guidelines for bronchiolitis state that ‘the use of this medical device is becoming widespread without demonstration of additional efficacy’. Recent studies by Kepreotes et al 2 and Riese et al 3 have shown that the use of ward-based HFNC in children with bronchiolitis did not reduce the hospital length of stay (LOS) or rate of admission to the paediatric intensive care unit (PICU), when compared with standard low-flow oxygen therapy.…”

Pediatric early warning score and deteriorating ward patients on high‐flow therapy

“…The other RCT reported similar data on duration of oxygen therapy, but found that initiation of HFNC reduced the proportion of children requiring PICU admissions . Finally, a large study of patients with bronchiolitis found that a ward‐implemented HFNC algorithm did not alter total hospital length of stay, transfer to PICU, intubation rate or 30 day readmissions …”

“…8 Finally, a large study of patients with bronchiolitis found that a ward-implemented HFNC algorithm did not alter total hospital length of stay, transfer to PICU, intubation rate or 30 day readmissions. 9 An important publication in 2014 outlined several aspects of implementing a HFNC program on the pediatric ward, including a proposed algorithm. 2 This documenttogether with a collaborative effort between intensivists, acute care pediatricians and respiratory therapistsled to the development and implementation of a ward HFNC algorithm at the Royal University Hospital (RUH), in Saskatoon, Canada.…”

Clinical Progress Note: High Flow Nasal Cannula Therapy for Bronchiolitis Outside the ICU in Infants

“…7,9,10,12 Two studies of infants with bronchiolitis showed HFNC therapy may prevent ICU transfer, but this benefit may be limited to rescue when standard oxygen therapy fails, rather than as a superior initial support modality. 7,9 Kepreotes et al 9 reported a single-center, randomized controlled trial comparing HFNC with standard oxygen therapy with 101 patients in each treatment arm. The primary outcome, median time to wean off oxygen, was not significantly different between the two groups: 24 hours (95% CI: 18-28) in the HFNC group versus 20 hours in the standard therapy group (95% CI: 17-34).…”