SUCCESSFUL USE OF HIGH FLOW NASAL CANNULA OUTSIDE OF THE CRITICAL CARE AREAS

Abstract

SESSION TITLE: Respiratory Care Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: October 18-21, 2020 PURPOSE: We continued to monitor and adjust our High Flow Nasal Cannula (HFNC) use in all areas. Our previous success of HFNC use outside of the critical care areas on our medical floors resulted in decreased ICU days and decreased noninvasive positive pressure ventilation (NIPPV) use. This study continues to evaluate the success of our HFNC use, including where to care for the patient, as well as whether we continue to use HFNC instead of NIPPV. Prior to our initiation of HFNC use on the medical floors, all patients on HFNC would have gone to the ICU on NIPPV. METHODS: We evaluated all patients on HFNC from 1/1/2016 to 12/31/2019. We looked at where HFNC was initiated, whether it was used on the medical floors or whether an ICU admission was needed. If an ICU transfer occurred, we then reviewed each case to determine if that patient required an escalation to NIPPV once in ICU. We then looked at the number of HFNC and NIPPV treatments from 1/1/2011 to 12/31/2019. RESULTS: From 2016-19 there were 1,517 patients admitted through the Emergency Department that were placed on HFNC. 564 patients were admitted directly to the medical floor on HFNC. 70 of these patients required a transfer to the ICU, where only 26 required NIPPV (26/564, 4.6%). 1,023 patients were admitted to the ICU and 568 were managed without NIPPV (56%). 188 patients were discharged to the floor from the ICU on HFNC, with none requiring rescue NIPPV. 129 HFNC ICU patients required NIPPV. 188 patients initially on NIPPV were transitioned to HFNC. 138 patients were on both during the day of admission to the ICU, not clear which was used first. HFNC patients treated on the medical floors were managed successfully without NIPPV 95.6% of the time. 494 ICU admissions were avoided, and many ICU days were decreased using HFNC. Over the 9-year period, there was a large increase in treatments with a shrinking percentage of NIPPV use. The average days on NIPPV was 1.65 and on HFNC was 2.96, many of these days on the floors. The average direct cost for patients treated with NIPPV, without HFNC, was $19,475. The average direct cost for HFNC, and no NIPPV was $10,194. CONCLUSIONS: Patients requiring HFNC can be safely managed outside of the critical care areas. Overall hospital costs were reduced. CLINICAL IMPLICATIONS: Managing HFNC outside of the critical care areas can free up ICU resources and decrease NIPPV use. Decreased NIPPV use allows for increased available therapist time, as NIPPV is time and labor-intensive for RTs. DISCLOSURES: Consultant relationship with Monaghan Medical Please note: $1001 - $5000 Added 03/02/2020 by Russell Acevedo, source=Web Response, value=Travel Consultant relationship with Vapotherm Please note: $1001 - $5000 Added 03/02/2020 by Russell Acevedo, source=Web Response, value=Travel Consultant relationship with Fisher & Paycal Please note: $1001 - $5000 Added 03/02/2020 by Russell Acevedo, source=Web Response, value=Grant/Research Support Consultant relationship with Fisher & Paykel Please note: $1001 - $5000 Added 03/03/2020 by Wendy Fascia, source=Web Response, value=Travel Consultant relationship with Fisher & Paykel Please note: $1001 - $5000 Added 03/03/2020 by Wendy Fascia, source=Web Response, value=Travel Removed 03/03/2020 by Wendy Fascia, source=Web Response Speaker/Speaker's Bureau relationship with Fisher Paykel Please note: $1001 - $5000 Added 03/03/2020 by Jennifer Pedley, source=Web Response, value=Travel