A pediatric high flow nasal cannula protocol standardizes in
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Respiratory illnesses compose the most common diagnosis of patients admitted to pediatric intensive care units. In pediatrics, high-flow nasal cannula (HFNC) therapy is an intermediate level of respiratory support with variability in practice. A pre-post intervention study of patients placed on HFNC therapy was conducted before and after implementation of a HFNC protocol.

This was a quality improvement / pre-post intervention study of pediatric patients who received HFNC therapy between January 2015 - April 2019. Patients were evaluated before and after implementation of a protocol that promoted initiation of higher flow and rapid weaning. The primary outcomes were initial flow and rate of weaning pre and post-protocol & secondary outcomes were HFNC failure rate (defined as escalation to non-invasive ventilation or mechanical ventilation) and length of hospital stay. Propensity matching was used to account for differences in age and weight pre and post-protocol.

--In total, 584 patients were included, 292 preprotocol, and 292 post-protocol. Median age was 20 months, and the indication for HFNC therapy was bronchiolitis in 29% of patients.
--Post-protocol patients compared to pre-protocol patients had significantly higher initial flow (median 14.5L/min vs. 10L/min) and a higher weaning rate of flow (median 4.1L/min/hr vs. 2.4L/min/hr).
--Post-protocol patients also had a lower HFNC failure rate (10% vs. 17%) and a shorter length of stay (5.97d vs. 6.80d).

Conclusively, among pediatric patients, implementation of a HFNC protocol increases initial flow, allows for more rapid weaning, and may decrease the incidence of escalation to non-invasive ventilation or mechanical ventilation.

Source: https://onlinelibrary.wiley.com/doi/abs/10.1002/ppul.25214?af=R
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