Effect of a Hospital-wide High-Flow Nasal Cannula Protocol on Clinical Outcomes and Resource Utilization of Bronchiolitis Patients Admitted to the PICU

Abstract

For bronchiolitis patients initially admitted to the PICU, initiating a guideline for HFNC use on the general pediatric wards is associated with reduced total hospital LOS and total hospital charges, with no difference in intubation rates or 30-day readmission.

National high‐flow nasal cannula and bronchiolitis survey highlights need for further research and evidence‐based guidelines

“…Some studies have compared infants with bronchiolitis who were treated with HFNC to historical controls who were treated in the same hospital with standard low‐flow oxygen administration. The results of these studies were positive, in line with subjective clinical experience .…”

“…The main impact of HFNC therapy may be the reduction of PICU treatment, which is much more expensive than treatment on the ward . As seen in the only RCT study, HFNC may have a special role as rescue therapy to prevent or shorten intensive care or to reduce the need to transfer patients to tertiary hospitals .…”

High‐flow Oxygen Therapy for Treating Bronchiolitis in Infants

“…Unfortunately, this trial does not evaluate the cost effectiveness of high‐flow oxygen therapy. Other published trials have suggested cost saving benefits from using high‐flow oxygen therapy . Kepreotes et al .…”

Safety and Efficacy of High-flow Nasal Cannula Therapy in the Pediatric Emergency Department

“…17,19,30 The flow rate is also chosen by age in some centers. 31 There has been no consensus about this issue yet. 14 Whichever flow rate is selected, HFNC has several advantages over conventional "low-flow" oxygen therapy in washout of nasopharyngeal dead space, gas exchange, oxygenation, decrease of inspiratory resistance and work of breathing, improvement of airway conductance and mucociliary clearance, reduction of the metabolic cost and providing an end-distending pressure to the lungs.…”

“…41 The studies have generally suggested two types of HFNC flow rate preference; age-based protocol and weight-based protocol. 30,31 Hutchings et al 42 , who have reported one of the best age-based protocols of HFNC flow rate, have recommended 6 L/min for patients up to 1 month, 8 L/min for 1-12 months, 10 L/min for 1-4 years and 12 L/min for 5 years and over. Other age-based studies have advised 2 L/min for patients <6 months, 4 L/min for 6-18 months and 8 L/min for those aged 18-24 months; or 8-12 L/min for infants and 20-30 L/min for children.…”