Table 1_Implementation of a nursing- and respiratory therapist-led high-flow nasal cannula pathway is associated with decreased ICU length of stay in bronchiolitis.docx

Background and objectivesBronchiolitis is a leading cause of pediatric intensive care unit (PICU) admission, with increased utilization of high-flow nasal cannula (HFNC) and non-invasive support over time. There is no universally accepted severity measure for patients with critical bronchiolitis nor standardized protocols for the implementation and de-escalation of HFNC.
DesignThis was a retrospective, single-center, pre–post analysis after the implementation of a respiratory therapist (RT)-registered nurse (RN) HFNC weaning pathway for bronchiolitis guided by a respiratory scoring system (RSS). Patients in the pre- and postepochs were compared by age, presence of complex chronic conditions, and initial RSS score.
Measurement and main resultsPatients by epoch were compared on PICU and hospital length of stay (LOS), duration of HFNC support, escalation to mechanical ventilation, and return to PICU after HFNC weaning. Patients in the pathway group had shorter PICU LOS (27 vs. 39 h, p < 0.001), hospital LOS (66 vs. 78 h, p < 0.001), and HFNC duration (11 vs. 15 h, p < 0.001). There was no increase in the need for rescue with either invasive or non-invasive mechanical ventilation between the two groups, and the rate of PICU bounce back was similar before and after pathway implementation. The average treatment effect on the treated pathway implementation was a reduction in ICU LOS by 9.8 h, hospital LOS by 13.8 h, and HFNC support by 5.2 h.
ConclusionThe implementation of an RT-RN HFNC weaning pathway guided by RSS was associated with reductions in PICU and hospital LOS as well as duration of HFNC therapy without an increase in measured adverse events, including the need for rescue with mechanical ventilation or PICU bounce back.