Impact of high flow nasal cannula implementation on the rate of intubation for bronchiolitis in Canada

Abstract

Abstract BACKGROUND Bronchiolitis affects more than one-third of children less than two years of age and is the most common reason for admission to hospital in the first year of life. Hospitalization rates have been on the rise, leading to an increase in healthcare expense, morbidity and impact on families. Bronchiolitis can have a heavy burden on health care resources including intubation and Intensive Care Unit (ICU) admissions. Non-invasive respiratory support with high-flow nasal cannula (HFNC) is being used more routinely in paediatric centers, though evidence of efficacy in bronchiolitis is insufficient to date. We examined the impact that implementation of HFNC has had on intubation rate and ICU admissions for patients with bronchiolitis in Paediatric centres in Canada. OBJECTIVES Our primary objective was to determine the impact of HFNC on intubation rate in Canada for paediatric patients with bronchiolitis. Our secondary objectives were to determine the impact of HFNC on ICU admission rate, ICU length of stay (LOS) and total hospital LOS. DESIGN/METHODS We conducted a multicentre, interrupted time series analysis to examine intubation rates pre- to post-implementation of HFNC for children less than 2 years with bronchiolitis. Data were obtained from the CIHI database using the Canadian Coding Standards. Paediatric tertiary centres that introduced HFNC between 2009–2014 were included, and data were collected from January 2005 to December 2016. RESULTS A total of 17,643 patients met inclusion criteria; 5,862 were before and 11,791 after implementation of HFNC. Comparing the two groups, there was no significant change in the rate of intubation after HFNC was introduced. There was also no significant change in the trend of average LOS in hospital between the two groups. There was a significant increase in ICU admission rates after the introduction of HFNC. Prior to HFNC implementation, there was an increase in average ICU LOS, with a decrease in the overall trend following the introduction of HFNC. CONCLUSION Initiating HFNC in Canadian paediatric centres resulted in no significant change in intubation rates or total LOS in hospital, but was associated with an increase in ICU admissions and a decrease in ICU LOS. Though HFNC does not prevent intubations, it may improve clinical severity with shorter time in ICU needed. Adopting use of HFNC on the ward in the tertiary care setting may help to address increasing ICU admission rates with associated healthcare expenses.