Stacey Gundry
University of Colorado At The Children's Hospital
Aurora, CO
Disclosure information not submitted.
Cameron Gunville, DO
Physician
University of Colorado At The Children's Hospital, United States
Disclosure information not submitted.
Title: Assessing Increased Flow Rates Of Heated High Flow Nasal Cannula In A Pediatric Intensive Care Unit
INTRODUCTION/HYPOTHESIS:
Respiratory failure and lower respiratory tract infections account for a large percentage of primary diagnosis causing Pediatric Intensive Care Unit (PICU) admission. Heated High Flow Nasal Cannula (HHFNC) is being increasingly utilized in the PICU to provide respiratory support by providing some positive pressure, CO2 clearance, and overall improvement in work of breathing. In addition, some studies have shown a reduction in intubation rates with the use of HHFNC in children. However, there is no current consensus on the definition of “high flow” oxygen rates and there is limited data on outcomes for patients treated with HHFNC. Furthermore, no prior studies have evaluated HHFNC use pre and post implementation of new clinical guideline as assessment of patient outcomes.
We hypothesize that the initiation and maximum HHFNC flow rates will be greater in patients in the post implementation cohort; secondly these increased oxygen flow rates will not have a significant impact on patient outcomes.
Methods:
Based on current literature, a new internal clinical guideline policy was established. Initiation rate of HHFNC of 1.5L/Kg/min and a maximum rate of 2L/Kg/min were recommended. A retrospective chart review identified patients with a primary diagnosis of respiratory failure with lower respiratory tract disease treated with HHFNC in the ICU. 215 patients were identified for pre-guideline cohort and 219 in post-guideline cohort.
Results:
Mean initial flow rate of HHFNC was higher (0.98L/kg/min vs 0.81L/Kg/min) after implementation of the clinical guideline, however did not reach the goal of 1.5mL/kg/min. Fewer patients (19.5% vs 31.2%) required initiation of noninvasive mechanical ventilation in the post guideline group. Additional analysis of patient outcomes related to length of stay, duration of HHFNC, and utilization of adjunct respiratory therapies and sedation were assessed.
Conclusions:
A clinical guideline recommending increased heated high flow oxygen rates was successfully implemented in a tertiary ICU. Further evaluation is needed to evaluate barriers to achieving goal initial flow rates in order to optimize HHFNC as a mode of respiratory support for pediatric patients. Further studies and subgroup analysis is required to evaluate which patients would benefit most from this therapy.