127 - Multi-center study of high-flow nasal cannula initiation and duration of use in patients admitted for mild to moderate bronchiolitis

Poster Number: 127
Publication Number: 127.415

Michelle Noelck, Oregon Health & Science University School of Medicine, Portland, OR, United States; Courtney Charvat, Emory University School of Medicine, Atlanta, GA, United States; Michelle Y. Hamline, University of California Davis, Sacramento, CA, United States; Mersine A. Bryan, University of Washington School of Medicine, Seattle, WA, United States; Olivia Ostrow, The Hospital for Sick Children, Toronto, ON, Canada; Valerie J. Riss, UVMMC, South Burlington, VT, United States; Kristin Shadman, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States; Steven L. Shein, UH Rainbow Babies & Children's Hospital, Cleveland, OH, United States; Robert Willer, University of Utah, Salt Lake City, UT, United States; Shawn Ralston, University of Washington School of Medicine, Seattle, WA, United States

Background: In the US, there is a paucity of multi-center data on rates of HFNC usage in hospitalized bronchiolitis patients due to the absence of standardized coding for the intervention, with HFNC often subsumed into the larger category of non-invasive mechanical ventilation.

Objective: To evaluate the rate of HFNC initiation and duration of use in patients admitted with mild to moderate bronchiolitis in a multi-center hospital cohort.

Design/Methods: As part of the Value in Inpatient Pediatrics Network quality improvement collaborative, medical records of patients with bronchiolitis admitted to general medical and intensive care units (ICU) from November 2019 to March 2020 were retrospectively reviewed for demographics, HFNC initiation, location of and duration of HFNC use, and length of stay (LOS). Inclusion criteria were patients 1-23 months admitted with a diagnosis of bronchiolitis. Exclusion criteria were medical complexity, prematurity 32 weeks, severe disease defined as any use of mechanical ventilation, and transfer from an outside hospital. Charts were sampled in two-week intervals and included either all admissions or a random sample of 20 admitted patients per interval for larger volume hospitals.

Results: Medical records of 8644 patients admitted to 66 hospitals were included. Table 1 provides hospital characteristics. Patients were 58.7% male, median age was 6 (IQR: 3-12) months, 10.1% were admitted to the ICU. Median hospital LOS was 48 (IQR: 28-81) hours. HFNC was initiated in 51.8% of patients; median duration of use was 42 (IQR 25-68) hours. HFNC initiation occurred most frequently in the emergency department (75.7%). Subgroup analyses revealed higher use in hospitals permitting initiation on medical units (n = 57) vs. restricting to the ICU (n=9) (RR=2.2, 95% CI: 2.0-2.5). (Table 2) Duration of HFNC use and LOS was the same in each cohort. Hospitals restricting use to ICU had fewer pediatric beds on average but were otherwise similar (Table 3). Conclusion(s): HFNC was initiated in the majority of patients with mild to moderate bronchiolitis admitted to this diverse cohort of hospitals during the 2019-2020 season, most commonly in the emergency department. Hospitals that restrict initiation to the ICU used significantly less HFNC in a similar cohort of patients.
Table 1: Characteristics of participating hospitals
Table 2: Outcomes subgrouped by hospital HFNC policy