High-Flow Nasal Cannula Use on the Medical Floors

Abstract

Background:

As a follow up report on last year’s abstract, we continued to monitor and adjust our High Flow Nasal Cannula (HFNC) use in all areas. Our previous success of HFNC use outside of the critical care areas on our medical floors resulted in decreased ICU days and decreased noninvasive ventilation (NIV) use. This study was to evaluate our continued success of appropriate HFNC use, including where to care for the patient, as well as whether we continued to decrease NIV cases. Prior to our initiation of HFNC use on the medical floors, all patients on HFNC would have gone to the ICU on NIV.

Methods:

We evaluated all patients on HFNC from 5/1/18-1/31/19. We looked at where HFNC was initiated, whether it was used on the medical floors or whether an ICU admission was needed. If an ICU transfer occurred, we then reviewed each case to determine if that patient required an escalation to NIV once in ICU. We stretched the limits of our current policy on HFNC on the medical floors, on a case-by-case basis, as our comfort with HFNC increased.

Results:

There were 99 HFNC treatments on 95 patients admitted through the Emergency Department. Fifty-one treated patients were admitted directly to the medical floor on HFNC. Two of these patients required a transfer to the ICU, where only one required NIV. Thirty-five of the 48 patients admitted directly to the ICU were managed with HFNC alone. Three of these patients transitioned to the floor on HFNC successfully, not requiring NIV. Eight of these ICU patients required escalation of respiratory support to NIV. Three patients admitted to the ICU on NIV were transitioned to HFNC successfully. Two patients were treated with NIV at night and HFNC during the day by schedule. HFNC patients treated on the medical floors were managed successfully without NIV 98% of the time. Eighty-eight of the ninety-five patients never required NIV. Forty-nine ICU admissions were avoided and many ICU days were decreased using HFNC.

Conclusions:

Patients requiring HFNC can be safely managed on the medical floor. This can free up ICU resources and decrease NIV use. Disclosures: Acevedo - consultant for Monaghan Medical and Sunovion.