High-flow nasal cannula utilization rates and outcomes in bronchiolitis patients

Lo, Huay-ying; Moore, Robert H.; Rodkey, Travis L.; Loveless, Jennifer; Keller, Maxine; Kancharla, Venkatesh; Gordon, Carla; Lawrence, Julia

doi:10.1542/peds.144.2ma5.482

Cited by 4 publications

(3 citation statements)

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“…possibility is that the widespread adoption of HFNC may be associated with observed trends as ward-based HFNC protocols have been associated with increased ICU use. [21][22][23][24] Its use may also justify the diagnosis of respiratory failure and may be associated with increased SOI index scores. As such, increasing HFNC use could explain both increasing costs and apparent increasing patient acuity.…”

Section: Discussionmentioning

confidence: 99%

“…It is not clear why resource use and apparent illness severity are increasing despite stable or improving patient outcomes. One possibility is that the widespread adoption of HFNC may be associated with observed trends as ward-based HFNC protocols have been associated with increased ICU use . Its use may also justify the diagnosis of respiratory failure and may be associated with increased SOI index scores.…”

Section: Discussionmentioning

confidence: 99%

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Trends in Hospital Costs and Levels of Services Provided for Children With Bronchiolitis Treated in Children’s Hospitals

et al. 2021

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IMPORTANCE Increasing hospital costs for bronchiolitis have been associated with increasing patient complexity and mechanical ventilation. However, the associations of illness severity and diagnostic coding practices with bronchiolitis hospitalization costs have not been examined. OBJECTIVETo investigate the association of patient complexity, illness severity, and diagnostic coding practices with bronchiolitis hospitalization costs. DESIGN, SETTING, AND PARTICIPANTSThis retrospective cross-sectional study included 385 883 infants aged 24 months or younger who were hospitalized with bronchiolitis at 39 hospitals in the

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Trends in Hospital Costs and Levels of Services Provided for Children With Bronchiolitis Treated in Children’s Hospitals

et al. 2021

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“…High-flow nasal cannula (HFNC) is a common respiratory support modality in children hospitalized with bronchiolitis 1 , 2 , 3 , 4 , 5 ; more than 50% of children were exposed to HFNC in a recent multicenter study. 6 Use of HFNC was initially restricted to the intensive care unit (ICU), but over time it has expanded to pediatric wards to reduce ICU use for patients with bronchiolitis.…”

Section: Introductionmentioning

confidence: 99%

Transition to Weight-Based High-Flow Nasal Cannula Use Outside of the ICU for Bronchiolitis

Willer,

Brady,

Tyler

et al. 2024

JAMA Netw Open

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ImportanceMost 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.ObjectiveTo measure the association between hospital transition to weight-based non-ICU HFNC use and subsequent ICU admission.Design, Setting, and ParticipantsThis 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.ExposureHospital-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 MeasuresProportion of patients with bronchiolitis admitted to the ICU.ResultsA 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 RelevanceResults 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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Is implementation of a hospital pathway for high‐flow nasal cannula initiation and weaning associated with reduced high‐flow duration in bronchiolitis?

Tarantino

Goodrich

Kerns

et al. 2022

Pediatric Pulmonology

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Background High‐flow nasal cannula (HFNC) therapy is widely used for children with bronchiolitis, but its optimal role remains uncertain. Our institution created and later revised a clinical pathway guiding HFNC initiation and weaning. Methods A retrospective review of 1690 bronchiolitis encounters was conducted. Trends in the duration of HFNC and hours spent weaning HFNC as proportions of the monthly hospital length of stay (LOS) for bronchiolitis, hospital LOS, and escalation of care were compared using interrupted time series (ITS) models across three study periods: Baseline (HFNC managed at provider discretion), Intervention 1 (pathway with initiation at 0.5 L/kg/min and escalation up to 2 L/kg/min), and Intervention 2 (revised pathway, initiation at the maximum rate of 2 L/kg/min). Both pathway iterations provided titration and weaning guidance. Maximum respiratory scores were used to adjust for case severity. Results After adjustment for severity and time, both HFNC duration and HFNC weaning time (as a proportion of monthly LOS) decreased at the start of Intervention 1, but subsequently increased. During Intervention 2, both these measures trended downward, returning to baseline. Total LOS did not change in the baseline or intervention periods. Escalation of care did not differ from baseline to the end of Intervention 2. Conclusion Initiating HFNC at higher flow rates with weaning guidance for children hospitalized with bronchiolitis was associated with a reduction in HFNC duration without differences in LOS or escalation of care. These findings suggest that standardization through clinical pathways can limit HFNC duration in bronchiolitis.

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High-flow nasal cannula utilization rates and outcomes in bronchiolitis patients

Cited by 4 publications

References 0 publications

Trends in Hospital Costs and Levels of Services Provided for Children With Bronchiolitis Treated in Children’s Hospitals

Trends in Hospital Costs and Levels of Services Provided for Children With Bronchiolitis Treated in Children’s Hospitals

Transition to Weight-Based High-Flow Nasal Cannula Use Outside of the ICU for Bronchiolitis

Is implementation of a hospital pathway for high‐flow nasal cannula initiation and weaning associated with reduced high‐flow duration in bronchiolitis?

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