RESPIRATORY THERAPIST-DRIVEN HIGH FLOW NASAL CANNULA PATHWAY AND PICU ADMISSION RATES FOR PEDIATRIC PATIENTS WITH ACUTE BRONCHIOLITIS: A RETROSPECTIVE STUDY

Abstract

SESSION TITLE: Respiratory Care Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: October 18-21, 2020 PURPOSE: The purpose of this study is to evaluate the effect of a newly implemented Respiratory Therapist (RT) driven “weight-based” (WB) high flow nasal cannula (HFNC) pathway on Pediatric Intensive Care Unit (PICU) admission rates of acute bronchiolitis patients in the pediatric acute care unit. METHODS: This study was approved by the UCSF Benioff Children’s Hospital Oakland Institutional Review Board. Data was retrospectively extracted via electronic medical records from January 2018 for the non-weight based pathway (non-WB) and January 2019 weight-based pathway (WB). The non-WB group pathway allowed RTs to adjust the HFNC to a maximum flow of 8 L/min and up to 50% FiO2. If a patient’s condition worsened, this would prompt a PICU consult and transfer, in order to provide an escalation of care. The reconfigured 2019 WB pathway, implemented in December 2018, allowed RTs to provide a higher level of care on the pediatric acute care unit by administering higher flow rates via a weight based approach in terms of liters per minute delivered. Patients weighing under 5 kg could receive flows up to 8 L/min, 5-10 kg patients could receive flows up to 10 L/min, 10-15 kg patients could receive flows up to 12 L/min, and 15 kg patients could receive flows up to 15 L/min. Non-WB group was compared to WB using the following outcome variables: PICU admission rate, hospital length of stay (LOS), and hours spent on HFNC. RESULTS: There was a total of 78 patients diagnosed with acute bronchiolitis (non-WB n=28; WB n=50). There was a significantly higher PICU admission rate for non-WB versus WB (57.1% versus 32%, P= 0.027, Eta=0.25). Mean hours spent on HFNC was lower in WB compared to non-WB (65.2 ± 38.6 versus 83.7 ± 43.8, p=0.05). Hospital LOS also reduced in WB to 5.8 ± 2.9 from 6.7 ± 3.8 non-WB, p=0.23). CONCLUSIONS: In this preliminary study, there was a significant reduction in PICU admission rate and hours spent on HFNC using the WB pathway. We believe this study will help pave the way for further exploration and implementation of RT driven pathways to be conducted in other facilities. Further research on cost-saving analysis for patients who are on RT driven pathways is needed. CLINICAL IMPLICATIONS: An RT Driven Weight Based High Flow Nasal Cannula pathway in pediatric acute care units may reduce PICU admissions for acute bronchiolitis patients. Further prospective analysis is required to confirm recommendations. DISCLOSURES: Stock market shareholder relationship with ABT, ABBV, AZN, BMY, DOW,JNJ, LLY,PFE Please note: $1-$1000 Added 06/09/2020 by Abdullah Alismail, source=Web Response, value=only Quar.Div when applied No relevant relationships by Noha Daher, source=Web Response No relevant relationships by Alex Golchehreh, source=Web Response No relevant relationships by David Lopez, source=Web Response No relevant relationships by MICHAEL TERRY, source=Web Response