Intensive Care Unit Utilization After Adoption of a Ward‐Based High‐Flow Nasal Cannula Protocol
- 20 May 2020
- journal article
- research article
- Published by Wiley in Journal of Hospital Medicine
- Vol. 15 (6), 325-330
- https://doi.org/10.12788/jhm.3417
Abstract
BACKGROUND Hospitals are increasingly adopting ward-based high-flow nasal cannula (HFNC) protocols that allow HFNC treatment of bronchiolitis outside of the intensive care unit (ICU). Our objective was to determine whether adoption of a ward-based HFNC protocol reduces ICU utilization. METHODS We examined a retrospective cohort of infants aged 3 to 24 months hospitalized with bronchiolitis at hospitals in the Pediatric Health Information System database. The study exposure was adoption of a ward-based HFNC protocol, measured by direct contact with pediatric hospital medicine leaders at each hospital. All analyses utilized an interrupted time series approach. The primary analysis compared outcomes three respiratory seasons before and three respiratory seasons after HFNC adoption, among adopting hospitals. Supplementary analysis 1 mirrored the primary analysis with the exception that the first season after adoption was censored. In supplementary analysis 2, effects among nonadopting hospitals were subtracted from effects measured among adopting hospitals. RESULTS Of 44 contacted hospitals, 41 replied (93% response rate), of which 18 were categorized as non-adopting hospitals and 12 were categorized as adopting hospitals. Included ward-based HFNC protocols were adopted between the 2010-2011 and 2015-2016 respiratory seasons. The primary analysis included 26,253 bronchiolitis encounters and measured immediate increases in the proportion of patients admitted to the ICU (absolute difference, 3.1%; 95% CI, 2.8%-3.4%) and ICU length of stay (absolute difference, 9.1 days per 100 patients; 95% CI, 5.1-13.2). Both supplementary analyses yielded similar findings. CONCLUSION Early protocols for ward-based HFNC were paradoxically associated with increased ICU utilization.Keywords
Funding Information
- National Center for Research Resources
- National Center for Advancing Translational Sciences
- National Institutes of Health (5UL1TR001067‐05, 8UL1TR000105, UL1RR025764)
This publication has 24 references indexed in Scilit:
- Physiologic Effect of High-Flow Nasal Cannula in Infants With BronchiolitisPediatric Critical Care Medicine, 2014
- The effect of high flow nasal cannula therapy on the work of breathing in infants with bronchiolitisPediatric Pulmonology, 2014
- High-flow nasal cannula therapy for respiratory support in childrenEmergencias, 2014
- High‐flow nasal cannula oxygen therapy for infants with bronchiolitis: Pilot studyJournal of Paediatrics and Child Health, 2014
- Effort of Breathing in Children Receiving High-Flow Nasal CannulaPediatric Critical Care Medicine, 2014
- Use of Interrupted Time Series Analysis in Evaluating Health Care Quality ImprovementsAcademic Pediatrics, 2013
- Prospective Multicenter Study of Viral Etiology and Hospital Length of Stay in Children With Severe BronchiolitisArchives of Pediatrics & Adolescent Medicine, 2012
- Reduced intubation rates for infants after introduction of high-flow nasal prong oxygen deliveryIntensive Care Medicine, 2011
- High Flow Nasal Cannulae Therapy in Infants with BronchiolitisThe Journal of Pediatrics, 2010
- A Simple, Positive Semi-Definite, Heteroskedasticity and Autocorrelation Consistent Covariance MatrixEconometrica, 1987