Implementation of a High-Flow Nasal Cannula Weaning Protocol in Bronchiolitis in a Pediatric Acute Care and Pediatric Intensive Care Unit

Abstract

Background:

High-flow nasal cannula (HFNC) has been widely adopted in the care of bronchiolitis patients for its role in reducing work of breathing and potential to prevent further respiratory decline. Studies have produced mixed data with some studies citing lower rates of escalation of care and others citing no change. The purpose of our study was to compare hospital length of stay (LOS) in children hospitalized with bronchiolitis to determine the effect of an HFNC weaning protocol utilized in the acute care and pediatric intensive care unit (PICU) areas of the hospital.

Methods:

The quality improvement project was a prospectively designed chart review to compare 120-day treatment periods from December to March for two consecutive years (2018 - 2019 and 2019 - 2020). All bronchiolitis patients age 0 through 2 years were placed on an HFNC weaning protocol utilizing a clinical respiratory scoring system and algorithm for prescriptive weaning. Patients were evaluated for their readiness to wean every 4 hours. The scoring system variables included respiratory rate, retractions, dyspnea, and auscultation. Weaning was completed by 25% decreases in flow until a mild score indicated removal of HFNC. Overall compliance with the protocol was measured through randomized audits on 20% of hospital patients each week. Compliance ranged from 34% to 72% over the course of the 120-day period. A total of 1,810 acute care patients and 539 PICU patients were compared.

Results:

In the acute care area of the hospital during year one (935, mean age 0.88 ± 1.50) mean LOS was 4.56 days and in year two following protocol implementation (875, mean age 0.83 ± 1.01) mean LOS was decreased to 3.62 days (P < .001). In the PICU during year one (307, mean age 0.86 ± 1.78) mean LOS was 7.71 days and in year two after protocol implementation (232, mean age 0.67 ± 1.32) mean LOS was decreased to 6.41 days (P < .01).

Conclusions:

The use of a standardized tool for scoring and weaning hospitalized patients with bronchiolitis was effective in reducing length of stay in both the acute care setting and the PICU. Compliance data demonstrated the highest bronchiolitis patient census correlated with the shortest LOS in the 4-month period.