(1285) Bronchiolitis High-Flow Nasal Cannula Protocol Is Associated With Decreased ICU Length of Stay

Introduction: High-flow nasal cannula oxygen therapy (HFNC) has been shown to reduce treatment failure in bronchiolitis. Effects on length of stay (LOS) and cost are uncertain. We sought to evaluate the effect of a respiratory therapy (RT) and nurse led HFNC weaning pathway and standardized floor transfer criteria on HFNC duration, LOS, and cost.

Methods: This was a single-center retrospective electronic medical record review at a tertiary children’s hospital merged with Pediatric Health Information Systems. We included patients under two years with bronchiolitis between 1/1/2018-12/31/2022 receiving HFNC. Demographics and clinical data were compared before and after pathway initiation (1/1/2021). The primary outcome was time on HFNC therapy. Secondary outcomes included PICU LOS, hospital LOS, and standardized unit cost. P < 0.05 was considered significant.

Results: There were 690 included encounters: 46.8% (323/690) before and 53.2% (367/690) after pathway initiation. 55.9% (347/690) encounters were male, 68.8% (427/690) were white, and 20.1% (125/690) had complex chronic conditions. The median (IQR) age was 6.4 (2.2, 13.3) months. There were no significant differences in age or complex chronic conditions before vs. after pathway initiation. The median (IQR) time on HFNC was 12.7 (6.1, 23.0) vs. 11.2 (6.0, 18.8) hours, before and after pathway initiation, respectively (p = 0.048). The median (IQR) PICU length of stay was 31.8 (21.6, 46.6) vs. 26.4 (19.7, 38.5) hours (p < 0.001). There were reductions in total hospital LOS after pathway initiation (69.9 [50.70, 102.1] vs. 66.6 [48.0, 96.6] hours) and standardized unit cost ($10,880 [($8,512, $14,147] vs. $9,937 [$7,986, $13,990]), but these did not meet the threshold for statistical significance (p = 0.055 for both). There was no difference in the percent of patients successfully weaned off HFNC (78.2% [287/367] vs. 82.0% [265/323], p = 0.11).

Conclusions: Implementation of a standardized, RT and nurse led HFNC weaning algorithm was associated with reductions in HFNC duration, PICU LOS, and a trend towards reduced cost. Reduced PICU LOS facilitated by standardized transfer criteria did not equate to reduced total hospital LOS. Thus, future work is needed to standardize discharge readiness criteria and reduce total hospital LOS.