349 - Will young bronchiolitis patients have a better clinical outcome if treated with High Flow Nasal Cannula at 1.5L/kg/min comparing with an arbitrary starting flow rate? A Retrospective Review
Saturday, April 23, 2022
3:30 PM – 6:00 PM US MT
Poster Number: 349 Publication Number: 349.204
Sarah E. DiPalma, Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo, Buffalo, NY, United States; Susana Ruano, John R. Oishei Children's Hospital, Cheektowaga, NY, United States; Sheri Wagner, Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo, Buffalo, NY, United States; Heather Territo, Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo, Buffalo, NY, United States; Brian Wrotniak, John R. Oishei Children's Hospital, Buffalo, NY, United States
Pediatric Emergency Medicine Fellow Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo Buffalo, New York, United States
Background: High flow nasal cannula (HFNC) has been shown to alleviate signs and symptoms of increased work of breathing for children with bronchiolitis, ultimately leading to decreased need for further intervention, including intubation. HFNC is universally used for the management of children with bronchiolitis; however, there continues to be great variation in its use. Universal guidelines have not been established, including the optimal flow rate for initiation. Historically, at our facility, HFNC flow initiation has been at the discretion of the ED provider.
Objective: The purpose of this study was to determine if initiating HFNC oxygen support at 1.5L/kg would lead to better clinical outcomes including: decreased admissions to the PICU, decreased need for further escalation of respiratory support, and shorter length of stay (LOS).
Design/Methods: This was a retrospective study of children less than 2 years of age diagnosed with bronchiolitis in the emergency department (ED). All patients included in the study required initiation of HFNC.
The study was divided into 2 groups. The pre-initiation of HFNC protocol (pre) group was from January 13, 2018 to January 12, 2020. This was prior to the launching of a hospital wide protocol for the initiation of HFNC. Group two, post-initiation of HFNC protocol group (post) was from January 13, 2020 to August 17, 2021, after incorporation of protocol to initiate HFNC at a rate of 1.5L/kg.
Results: A total of 1213 patients were enrolled (922 in the pre group and 291 in the post group). Average L/kg initiation rate for HFNC was 1.28 L/kg in the pre group vs 1.41 L/kg in the post group (p < 0.05). In the pre group 63% of patients required ED admission to the PICU vs 49% in the post group (p < 0.05). After admission, 46% of patient in the pre group required transfer from the floor to the PICU compared to 39% in the post group (p < 0.05). There was no difference in escalation of care between groups. 10% of patients in pre group vs. 15% in post group required non-invasive ventilation i.e., RAM or RTX (p= 0.16) and 5% of patients in the pre group required intubation vs 8% in post group (p= 0.056). We found no difference in LOS between groups (3.8 days in both groups (p= 0.95)). Conclusion(s): Initiation of HFNC protocol starting patients at 1.5L/kg compared to an arbitrary starting flow rate was associated with decreased PICU admissions and decreased floor to PICU transfers. HFNC initiation rate of 1.5L/kg should be considered when starting patients on HFNC to decrease unnecessary PICU admissions.
