High-Flow Nasal Cannula Use in Children with Bronchiolitis in a Community Hospital Setting: Evaluation of Safety, Flow Limits, and Intensive Care Unit Transfers.

Abstract

High-flow nasal cannula (HFNC) oxygen therapy is being used in pediatric wards at increasing rates, including community hospitals that do not have a pediatric intensive care unit (PICU). This study describes the use of HFNC in a pediatric ward at a community hospital, evaluating safety, flow limits, and outcomes for children transferred to a PICU. A descriptive, single center retrospective cohort study of consecutive subjects from birth to 24 months of age treated with HFNC for bronchiolitis in our pediatric ward from January 2016 to May 2019. We report demographic and clinical characteristics of the patients. The outcomes of interest include episodes of aspiration, pneumothorax, intubation, cardiorespiratory arrest, and transfers to the PICU. There were 157 hospitalizations. One hundred twenty-three children (78.3%) were weaned off HFNC and discharged to home. Flow rates of up to 3 L/kg/min (average, 1.22 L/kg/min; range 0.28-3.08 L/kg/min) were tolerated. Of the 34 children transferred to the PICU, 29 were continued on HFNC, 1 required continuous positive airway pressure, and 4 were intubated. The median time from initiation of HFNC to transfer was 13 hours (interquartile range 6.0-23.0). There were no documented episodes of aspiration, pneumothorax, cardiorespiratory arrest, or death. HFNC could be safely administered in a community hospital pediatric ward without PICU expertise and capability. Most patients who deteriorate on HFNC do so within the first 24 hours when close monitoring is needed. For children transferred to a PICU, the vast majority did not require more invasive forms of respiratory support.