High-Flow Nasal Cannula Use on the Medical Floors

Abstract

Background:

As our use and comfort level with high-flow nasal cannula (HFNC) has increased we started to transition patient to the medical floors with HFNC. HFNC has been well tolerated by our COPD population and our use of noninvasive ventilation (NIV) has decreased. These are patients that would have been admitted to our intensive care unit (ICU) and likely placed on NIV. This study was to evaluate the success rate of these patients on the medical floors.

Methods:

We implemented a policy to allow HFNC on the medical floors in March of 2018. Maximal allowed FIO₂ on any floor outside ICU was 50% unless patient was at end of life. We evaluated all patients who received HFNC from 5/1/2017 to 4/30/2018. We looked at where the HFNC was initiated, if it was used on the medical floor and if an ICU transfer was needed.

Results:

147 patients received HFNC during this period. 72 were initiated in the emergency department (ED), 41 were initiated in the ICU and 34 were either transferred from the ICU to the medical floor on HFNC or initiated on the medical floor. Of the ED patients 39 were admitted to the ICU and 33 were admitted directly to the medical floor. Of these 33 medical floor patients 3 required ICU transfer. Of the 34 other medical floor patients 5 required ICU transfers. Of the 67 patients managed on the medical floor 59 avoided ICU care (88% success rate).

Conclusions:

Patients requiring HFNC can be safely managed on the medical floor. This can free up ICU resources and decrease NIPPV use.

Disclosures:

Acevedo – Sunovion and Monaghan Medical.