(1259) An Evidence-Based Holiday Protocol to Decrease High-Flow Nasal Cannula Utilization in Bronchiolitis

Introduction: High flow nasal cannula (HFNC) has been widely accepted as standard therapy for infants with acute respiratory failure due to bronchiolitis in recent years. While its use has been associated with decreased rates of intubation, it has also been associated with increased duration and cost of hospitalization. Given this paradoxical effect, there have been efforts to decrease unnecessary use of HFNC. Our initial phases of this research consisted of determining our baseline protocol compliance, assessing barriers to compliance, and addressing those barriers to optimize our compliance, which led to a decrease in HFNC duration. Our ongoing quality improvement (QI) efforts seek to further optimize HFNC use through the introduction of an evidence-based holiday protocol.

Methods: In this IRB-exempt QI study, we included patients aged 30 days to 24 months who were admitted to the PICU with bronchiolitis and treated with HFNC. Following our initial optimization phase, our multidisciplinary team of pediatric intensive care unit (PICU) physicians, respiratory therapists, and nurses developed and implemented additional changes through Plan-Do-Study-Act (PDSA) cycles. Our first PDSA cycle consisted of standardizing HFNC weaning tiers by 0.5LPM/kg. This was followed by PDSA 2, in which we introduced a HFNC holiday that allowed eligible patients to transition from 1LPM/kg to low-flow nasal cannula or room air rather than gradually weaning until off. With the use of run charts, we were able to measure change following each intervention.

Results: Following our initial optimization phase, we found decreases in our primary and secondary outcomes, from a baseline HFNC duration, PICU length of stay (LOS), and hospital LOS of 39.7 to 35.5 hours, 49.1 to 47.2 hours, and 90.1 to 81.7 hours, respectively. Following our current PDSA cycles, we saw further improvement in our HFNC duration to 33.8 hours; however, our decrease in PICU and hospital LOS did not persist, with trends returning toward our baseline.

Conclusions: Our results demonstrate both protocol feasibility and potential for significant improvement in our unit’s HFNC utilization through implementation of a HFNC holiday, however more longitudinal data is needed to show sustainability of these findings across seasons.